心脏机械换瓣术后妊娠妇女孕期处理效果的临床观察

目的:探讨心脏机械瓣膜置换术后妊娠妇女孕期终止妊娠的方式、孕期抗凝以及母婴并发症。方法:对32例次有记录换瓣术后妇女妊娠期的处理进行回顾性分析。结果:32例次妊娠中,14例次非意愿性妊娠,2例人流后放置曼月乐环效果好;整个孕期均常规应用华发林抗凝,无1例孕产妇发生瓣膜血栓和栓子栓塞并发症,胎儿发生流产3例,死胎1例,畸形2例。15例次晚期妊娠,11例择期剖宫产,其中1例发生产后大出血,1例急诊剖宫产出现产后大出血,3例阴道分娩中1例产后大出血;1例孕妇中孕引产过程中发生心衰,同时产后大出血。结论:换瓣术后生育年龄妇女急需有效控制生育,曼月乐环可能满足她们的需要;孕期单一、小剂量华发林抗凝对孕产妇比较安全;终止妊娠方式宜选择择期剖宫产。

The clinical observation of management on pregnancy women after mechanical heart valve replacement

Objective:To discuss the modes of termination of pregnancy about women after mechanical heart valve replacement and anticoagulation therapy and the effects on both mothers and embryos.Methods:The managements of 32 cases were analyzed through retrospection about pregnancy women after mechanical heart valve replacement whose medical records were conserved.Results:Among those 32 cases,14 cases were no-willing gestations and 2 pregnancy women were placed IUD of Mirena after induced abortion whose effect was good.All people among pregnancy used Warfarin as their routine anticoagulative treatment and none of them had complications of valve blood bolts and so on,but 3 cases had spontaneous abortion and 1 case had fetal death and 2 cases had fetal deformation.There were 15 cases late pregnancy.Among 11 cases selective cesarean,one of them developed postpartum hemorrhoea,but one emergency cesarean and one of 3 vaginal delivery cases developed postpartum hemorrhoea;1 artificial labor of intermediate stage pregnancy occurred both congestive heart failure and postpartum hemorrhoea.Conclusion:The mechanical heart valve replacement for women in reproductive age should control their birth in effect,Mirena perhaps could suit for the requirement.The anticoagulation therapy with low dosage of warfarin is safe for the mothers during pregnancy following mechanical heart valve replacement;the most suitable termination mode of pregnancy is selective cesarean.