摘要【目的】探讨合并结构性心脏病孕妇的妊娠结局。【方法】回顾性分析40例诊断为结构性心脏病孕妇(观察组)的临床资料,另外选取80例健康孕妇(对照组)的临床资料,比较两组妊娠结局。【结果】40例合并结构性心脏病孕妇中,风湿性心脏病10例(10/40,25.00%),先天性心脏病30例(30/40,75.00%)。观察组死胎、早产、医源性胎儿丢失发生率、孕妇围产期死亡率、孕妇入ICU率、剖宫产率、新生儿入新生儿重症监护病房(NICU)率均高于对照组(P<0.05);新生儿出生体重、1 min及5 min Apgar评分、出生孕周均低于对照组(P<0.05)。观察组孕妇中纽约心脏病协会(NYHA)分级Ⅲ~Ⅳ级组胎儿早产、孕妇围产期死亡率、剖宫产的发生率及新生儿入NICU率均高于NYHA分级Ⅰ~Ⅱ级组(P<0.05),新生儿出生体重及孕周均低于NYHA分级Ⅰ~Ⅱ级组(P<0.05)。【结论】合并结构性心脏病孕妇不良妊娠结局发生率高,尤其是NYHA分级Ⅲ~Ⅳ级的孕妇。
Abstract:【Objective】To investigate the pregnancy outcomes of pregnant women with structural heart disease.【Method】The clinical data of 40 pregnant women diagnosed with structural heart disease (observation group) and 80 healthy pregnant women (control group) were retrospectively analyzed, and the pregnancy outcomes of the two groups were compared.【Results】Among the 40 pregnant women with structural heart disease, 10 cases (10/40,25.00%) were rheumatic heart disease and 30 cases (30/40,75.00%) were congenital heart disease.The incidences of stillbirth, premature birth, iatrogenic fetal loss,perinatal mortality,ICU admission,cesarean section,NICU admission in the case group were higher than those in the control group (P<0.05).The birth weight, Apgar score at 1 and 5 minutes and the gestational age of neonates in the case group were lower than those in the control group (P<0.05).The incidences of premature birth, perinatal death, cesarean section and NICU admission in the NYHA grade Ⅲ-Ⅳ group were higher than those in NYHA grade Ⅰ-Ⅱ group (P<0.05).The birth weight and the gestational age of neonates in the NYHA grade Ⅲ-Ⅳ group were lower than those in NYHA grade Ⅰ-Ⅱ group (P<0.05).【Conclusion】There is a high incidence of adverse pregnancy outcomes in pregnant women with structural heart disease, especially in those with NYHA grade Ⅲ-Ⅳ.
李巧荣, 龙湘党, 敖琨, 谢娟娟, 卓宇, , 文琼莉, ,. 合并结构性心脏病孕妇的妊娠结局分析[J]. 医学临床研究, 2023, 40(10): 1441-1443,1447.
LI Qiaorong, LONG Xiangdang, AO Kun, et al. Analysis of Pregnancy Outcomes in Pregnant Women with Structural Heart Disease. JOURNAL OF CLINICAL RESEARCH, 2023, 40(10): 1441-1443,1447.
[1] SUBBAIAH M, SHARMA V, KUMAR S, et al.Heart disease in pregnancy:cardiac and obstetric outcomes[J].Arch Gynecol Obstet,2013,288(1):23-27. [2] 林晶,陈蕾.妊娠合并心脏病分娩方式的选择[J].实用妇产科杂志,2020,36(8):578-580. [3] REGITZ-ZAGROSEK V, ROOS-HESSELINK J W, BAUERSACHS J, et al.2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy[J].Kardiol Pol,2019,77(3):245-326. [4] 陈琼,汪文雁, 郑剑兰. 妊娠合并常见心脏病产时处理[J].实用妇产科杂志,2020,36(8):566-570. [5] OWENS A, YANG J, NIE L Z, et al.Neonatal and maternal outcomes in pregnant women with cardiac disease[J].J Am Heart Assoc,2018,7(21):e009395. [6] LIMA F V, YANG J, XU J J, et al.National trends and in-hospital outcomes in pregnant women with heart disease in the United States[J].Am J Cardiol,2017,119 (10):1694-1700. [7] 苏炳峰,苏丽香,许巧能.妊娠合并结构性心脏病患者妊娠结局的影响因素[J].华夏医学,2022,35(4):69-73. [8] 乔璞.妊娠合并心脏病患者不良妊娠结局的影响因素[J].河南医学研究,2021,30(27):5048-5051. [9] 宋晓维,张英,苏杭.妊娠心脏病孕妇不良妊娠结局影响因素分析[J].护理实践与研究,2021,18(8):1151-1153. [10] SCHLICHTING L E,INSAF T Z,ZAIDI A N,et al.Maternal comorbidities and complications of delivery in pregnant women with congenital heart disease[J].J Am Coll Cardiol,2019,73 (17):2181-2191. [11] 黄莉,张莉,李洪艳,等.孕产妇不良妊娠结局危险因素的巢式病例对照研究[J].中国现代医学杂志,2015,25(9):106-109. [12] SLIWA K,BARIS L,SINNING C,et al.Pregnant women with uncorrected congenital heart disease:heart failure and mortality[J].JACC-Heart Fail,2020,8 (2):100-110. [13] 赵骏达,梁凌云,殷艳,等.高龄孕产妇心脏病特点及妊娠结局分析[J].中国医药导报,2021,18(2):69-72. [14] 杨慧霞, 狄文. 妇产科学[M]. 北京:人民卫生出版社, 2015. [15] 刘兴会,马宏伟,张彦.控制剖宫产率从减少阴道分娩并发症做起[J].中国实用妇科与产科杂志,2022,38(8):769-772. [16] HU J Q,YE Y X,LU A Y,et al.Pregnancy outcomes in patients with heart disease in China[J].Am J Cardiol,2020,125 (11):1718-1724. [17] 杨淑芹,季景环,高芳.妊娠合并心脏病孕妇心功能情况及不良妊娠结局影响因素分析[J].临床误诊误治,2020,33(5):90-94. [18] 何志宏,张羽,牛永华,等.正常妊娠孕妇孕期常用超声心动图指标的测定及参考值的确定[J].中国实用妇科与产科杂志,2019,35(10):1142-1149. [19] 林建华.国内外妊娠合并心血管疾病的指南和专家共识解读[J].实用妇产科杂志,2020,36(8):588-590.