妊娠合并风湿性心脏病患者心功能状态对妊娠结局的影响

目的探讨妊娠合并风湿性心脏病患者心功能状态对妊娠结局的影响。方法对1993年1月至2006年7月在我院产科分娩的、资料齐全的65例妊娠合并风湿性心脏病患者的临床资料进行回顾性分析。根据患者的二尖瓣狭窄程度分为二尖瓣正常组20例（瓣口面积〉4．0cm^2）、轻度狭窄组11例（瓣口面积2．5—4．0cm^2）、中度狭窄组14例（瓣121面积1．5—2．5cm^2）以及重度狭窄组20例（瓣口面积〈1．5cm^2）;根据是否伴有肺动脉高压分为正常压力组33例[肺动脉压〈30mmHg（1mmHg=0．133kPa）]、轻度升高组18例（肺动脉压31—49mmHg）、中度升高组7例（肺动脉压50～79mmHg）和重度升高组7例（肺动脉压≥80mmHg）;根据孕前是否进行心脏手术分为心脏手术组14例和非心脏手术组51例;根据患者的不同心功能状态分为Ⅰ级组24例、Ⅱ级组13例、Ⅲ级组13例、Ⅳ级组15例,观察各组的围产儿结局。分析以上各种因素对妊娠合并风湿性心脏病患者妊娠结局的影响。结果（1）二尖瓣正常组患者心功能Ⅰ～Ⅱ级者为80％（16／20）,Ⅳ级组患者中,80％（12／15）在中度狭窄组（6例）及重度狭窄组（6例）,与二尖瓣正常组和轻度狭窄组的心功能Ⅳ级发生率（20％,3／15）比较,差异有统计学意义（P〈0．05）。（2）正常压力组患者心功能Ⅰ～Ⅱ级者为73％（24／33）,重度升高组患者心功能Ⅳ级的发生率（6／7）明显高于心功能Ⅰ级的发生率（1／7）,两者比较,差异有统计学意义（P〈0．05）。（3）心脏手术组患者心功能Ⅰ～Ⅱ级发生率为71％（10／14）,Ⅲ级和Ⅳ级的发生率均为14％（2／14）,前后两者比较,差异有统计学意义（P〈0．05）;非心脏手术组患者Ⅰ～Ⅳ级心功能发生率之间分别比较,差异均无统计学意义（P〉0．05）。（4）心功能Ⅰ～Ⅲ级组患者的平均孕周及新生儿平均出生体重分别比较,差异无统计学意义（P〉0．05）;而心功能Ⅳ级组平均孕周为（34．6±3．1）周,新生儿平均出生体重为（2176±186）g,明显低于心功能Ⅰ级组,两组比较,差异有统计学意义（P〈0．05）。心功能Ⅲ～Ⅳ级组患者中,共发生医源性流产和引产9例（14％,9／65）,医源性早产18例（28％,18／65）,胎儿生长受限4例（6％,4／65）,围产儿死亡3例（5％,3／65）;而心功能Ⅰ～Ⅱ级组患者以上指标均为0。（5）65例妊娠合并风湿性心脏病患者中合并心房纤颤者7例,其心功能Ⅲ～Ⅳ级（心功能衰竭）的发生率为6／7。结论妊娠合并风湿性心脏病患者伴中、重度二尖瓣狭窄、重度肺动脉压升高及心房纤颤,容易发生心功能衰竭危及生命,不宜妊娠。已妊娠者应尽早终止妊娠;心功能Ⅲ～Ⅳ级的妊娠合并风湿性心脏病患者的医源性流产、早产和围产儿病率均增加,围产儿结局不良。     

妊娠合并先天性心脏病对新生儿的影响

妊娠合并心脏病是高危妊娠之一，随着风湿性心脏病的减少及心脏外科手术的迅速发展，妊娠合并先天性心脏病已跃居妊娠合并心脏病首位。母亲患不同类型的先天性心脏病对新生儿的影响显著，母亲的心功能状态也与新生儿疾病发生有关。为保证母儿安全，明确先天性心脏病患者的妊娠风险，现对我院收治的妊娠合并先天性心脏病患者45例进行分析。     

妊娠合并心脏病伴肺动脉高压患者的妊娠结局

目的 探讨妊娠合并心脏病伴肺动脉高压患者的妊娠结局。方法 收集1996年1月至2004年8月间,我院产科收治的61例妊娠合并心脏病伴肺动脉高压患者的临床资料（其中先天性心脏病36例,风湿性心脏病21例,心律失常1例,原发性肺动脉高压性心脏病2例,系统性红斑狼疮性心脏病1例）,根据肺动脉压力情况分为轻度组32例[30-49mmHg（1mmHg=0．133kPa）],中度组23例（50～79mmHg）,重度组6例（t〉80mmHg）,分析各组心脏病种类、心功能级别、终止妊娠孕周和方式以及母儿结局。结果 （1）轻度组心功能Ⅰ-Ⅱ级者23例,中度组心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级的发病例数分别为9、5、5、4例,重度组心功能Ⅲ-Ⅳ级者5例。（2）风湿性心脏病患者中,中、重度肺动脉高压者11例,占52％（11／21）;发生严重心功能衰竭者9例,占43％（9／21）,先天性心脏病患者中,以轻、中度肺动脉高压者为主（97％,35／36）,且以心功能Ⅰ-Ⅱ级者为主（81％,29／36）。（3）轻度组足月妊娠24例,新生儿平均体重为2744g;中度组足月分娩11例,早产8例,医源性流产4例;重度组足月分娩1例,早产3例,医源性流产2例。各组围产儿疾病发生率比较,差异无统计学意义（P〉0．05）。（4）妊娠合并心脏病伴肺动脉高压者的分娩方式以刮宫产分娩为主,占79％（48／61）。（5）孕产妇死亡率为2％（1／61）,医源性胎儿丢失率为13％（8／61例）。结论 随着肺动脉压力的升高,孕妇心功能衰竭的发生率随之增加,围产儿疾病发生率和胎儿丢失率也明显增加;妊娠合并风湿性心脏病患者中、重度肺动脉高压的发生率高于先天性心脏病患者;手术终止妊娠是比较安全的分娩方式。     

妊娠合并先天性心脏病伴肺动脉高压患者的母婴结局

目的:探讨妊娠合并先天性心脏病(先心病)伴肺动脉高压患者的母婴结局.方法:对2005年12月至2009年9月在四川大学华西第二医院产科诊治的21例妊娠合并先心痛伴肺动脉高压患者的临床资料进行回顾性分析,根据肺动脉收缩压分为轻度组(35～54 mmHg)4例、中度组(55～74 mmHg)6例和重度组(≥75 mmHg)11例,比较各组心脏病种类、心功能级别、终止妊娠的孕周和方式以及母婴结局.结果:①先心痛以房间隔缺损(房缺)和室间隔缺损(室缺)为主,均分别占38.1%(8/21),有2例(9.5%,2/21)为室缺合并房缺,2例(9.5%,2/21)动脉导管未闭,1例完全性肺静脉异位引流(心内型),其中轻、中度组以房缺为主(70.0%,7/10);重度组以室缺为主(72.7%,8/11).②轻、中度组心功能以Ⅰ～Ⅱ级为主,轻度组有1例心功能Ⅲ级,中度组有2例心功能Ⅲ级,均无心力衰竭发生,孕产妇结局良好;而重度组心功能Ⅲ～Ⅳ级达90.9%(10/11),有3例产前或产后出现早期心力衰竭表现或发生心力衰竭,1例死亡.③分娩方式以剖宫产为主,占95.2%(20/21);轻、中度组均足月分娩,重度组足月产3例,早产6例;④中度组有1例足月低体重儿并发新生儿轻度窒息;重度组有3例足月低体重儿,6例早产儿,各组均无新生儿死亡;重度组死胎2例.结论:妊娠合并先心病伴肺动脉高压患者的肺动脉压力越高,母婴妊娠结局越差;剖宫产终止妊娠是较安全的分娩方式.     

妊娠合并先天性心脏病伴肺动脉高压79例妊娠结局分析

目的分析妊娠合并先天性心脏病伴肺动脉高乐患者的妊娠结局。方法回顾性分析2009年1月至2013年6月北京安贞医院妇产科收治的79例妊娠合并先天性心脏病伴肺动脉高压患者的临床资料,根据肺动脉压力将其分为轻度组、中度组、重度组。分析各组先天性心脏病种类、心功能级别、终止妊娠的方式以及母婴结局。结果先心病类型以房间隔缺损（房缺）和室间隔缺损（室缺）为主,肺动脉高压轻度组心功能以Ⅰ～Ⅱ级为主,重度组心功能以Ⅲ～Ⅳ级为主。79例患者中,行医源性流产者16例（20．8％）,经阴道分娩5例（6．5％）,剖宫产56例（72．7％）。重度组医源性流产率高于其他组,足月分娩率低于其他组,差异有统计学意义（P〈0．05）。新生儿早产20例（32．8％）,足月产41例（67．2％）,死产1例,随着肺动脉压力的增加,早产的发生率增加,三组之间相互比较差异有统计学意义（P〈0．05）。结论肺动脉高压患者应在妇产科及心脏科医师指导下妊娠,不宜妊娠者应及早终止妊娠。孕产妇终止妊娠方式以剖宫产为主,麻醉方式以硬膜外麻醉为宜。     

妊娠合并风湿性心脏病的超声心功能研究

本文应用超声心动图时21例风湿性心脏病患者妊娠期的心功能变化进行了连续定量评价.8例患者在妊娠期发生心力衰竭,其中妊娠晚期心力衰竭的发生率占全部心衰病例的62.5%,它与心输出量呈最大上升的时间是一致的.14例患者在妊娠期并发心动过速.本研究认为心输出量增多、心动过速和妊高征是导致风心病妊娠患者发生心力衰竭的主要危险因素.     

妊娠合并心脏病58例临床分析

妊娠合并心脏病是严重威胁母婴安全的妊娠期合并症，临床上通过评价育龄妇女或孕妇心功能状态来决定是否可以继续妊娠。本文对1999-01—2005-08我院58例妊娠合并心脏病临床资料进行回顾性分析。     

44例妊娠合并先天性心脏病母儿结局临床分析

目的探讨孕妇先天性心脏病类型与母儿不良事件的相关性。方法回顾性分析1998年1月至2008年12月北京大学人民医院产科分娩的44例先天性心脏病孕妇及胎儿临床资料。结果孕妇先天性心脏病类型前3位依次为房间隔缺损36.36%(16/44)、动脉导管未闭18.18%(8/44)、室间隔缺损15.91%(7/44)和二尖瓣脱垂15.91%(7/44)。共发生20次不良事件,其中5次为心脏不良事件,15次为产科不良事件。发生不良事件的前3位孕妇先天性心脏病的类型依次为房间隔缺损40%(8/20)、动脉导管未闭20%(4/20)和主动脉瓣狭窄20%(4/20)。产科不良事件中,子痫前期3例,早产4例,胎儿生长受限2例,新生儿需入住NICU3例,新生儿轻度窒息2例,子代先心病1例。结论孕妇先天性心脏病中房间隔缺损合并肺动脉高压可能会增加母儿风险,但大部分母儿结局良好。     

妊娠合并心脏病266例临床分析

探讨妊娠合燕心脏病患者不同心功能状态对母亲和围产儿的影响。方法对我国院１９９３年１月至１９９９年３月间、２６６例妊娠合并心脏病患者的临床资料进行回顾性分析。结果（１）妊娠合并心脏病患者以心肌炎、心肌炎后遗症及不明原因性心律失常的发生率最高（１７９例,６７．２９％）,其次为先天性心脏病（４１例,１５．４１％）,其发生率高于风湿性心脏病（２８例,１０．９１％）。（２）风湿性心脏病的先天性心脏病是导致心     

预激综合征患者围产期室上性心动过速发作及对妊娠结局的影响

目的探讨妊娠合并预激综合征围产期室上性心动过速发作特点及对妊娠结局的影响。方法对北京大学第三医院1993年1月至2009年6月间妊娠合并预激综合征38例住院分娩患者的临床资料进行回顾性分析。结果妊娠合并预激综合征患者围产期发作室上性心动过速(SVT)5例,占13.16%(5/38),共发作SVT29次;在妊娠28～36周末(51.72%,15/29)及妊娠13～27周末(34.48%,10/29)发作所占的比例最高。妊娠期SVT发作增加者占10.53%(4/38)。妊娠前确诊预激综合征且合并SVT(未治疗)7例患者中4例在妊娠期没有发作SVT。围产期出现的29次室上性心动过速发作中,7次(24.14%)通过刺激迷走反射、18次(62.07%)经药物治疗好转,4次(13.79%)发作行经食管心脏调搏心律恢复正常。预激综合征患者围产期室上性心动过速发作与未发作组相比,平均分娩孕周、新生儿出生体重及分娩方式差异均无统计学意义(P0.05)。结论预激综合征患者少部分围产期室上性心动过速发作增加,可能与妊娠期血容量的快速增加有关;规范合理的治疗可以有效地控制妊娠期室上性心动过速发作,妊娠结局良好。     

Maternal mortality from cardiac disease in Turkey: a population-based study

Objective: Population-based studies on maternal deaths in Turkey are rare. The aim of the present study was to analyze the cardiac causes of all maternal deaths in Turkey between 2007 and 2009. Materials and methods: In this retrospective study, case files of all pregnancy-associated deaths recorded in Turkey between 2007 and 2009 were reviewed. Records for all pregnancy-associated deaths were reviewed by five authors to identify 129 cases in which a cardiac disease seemed to be the reason. For each of the 129 cases, maternal age, gravidity, parity, antenatal care attendance, district of residence, year of death, mode of delivery, perinatal outcome, and clinical history preceding death were recorded. Results: During the study period, 779 maternal deaths were identified. Our estimate of the maternal mortality ratio (MMR) in 3-year period was 19.7 per 100,000 live births. The report lists 779 deaths, 411 direct and 285 indirect. Indirect obstetric causes of maternal death were primarily cardiac disorders and cerebrovascular diseases. Maternal mortality due to cardiac disease was 15.5% in 2007 and 18.4% in 2008. Valvular heart disease was the leading cause of maternal death from cardiac reasons (25.6%). Maternal mortality due to cardiac disease increased with age. Conclusion: The main cause of indirect maternal death has been cardiac disease in 3-year period.     

妊娠期心功能不全的防治

需要根据心脏病种类和心功能状态来评判心脏病妇女是否允许妊娠或继续妊娠。目前产科仍然常用纽约心功能分级法。允许妊娠的心脏病患者要加强孕期保健,防止产科并发症的发生,去除诱发心衰的不良因素,减轻心脏负荷,增加心肌收缩力。一旦发生心力衰竭(心衰),按急性心衰和慢性心衰的不同治疗原则处理。终止妊娠是改善心功能的有效方法。     

Maternal cardiac disease in pregnancy

The 2019 MBRRACE-UK report highlighted the prevalence of cardiac disease amongst pregnant women, and its role as a driver in maternal mortality. Advancing maternal age, a rise in cardiovascular co-morbidities, and the improvements in congenital heart disease care have all contributed to this static prevalence, despite improvements in obstetric and cardiac care. In this review we consider the importance of pre-conception counselling for women with known heart disease, review the physiological changes of pregnancy which place increased demand on the cardiovascular system, and explore maternal risk, from a cardiovascular perspective. Contemporary management of women with moderate to severe heart disease during pregnancy should be delivered by the pregnancy heart team, a term coined by the European Society of Cardiology in its 2018 guidelines. Individualized care empowers trust and shared decision making and early access to multidisciplinary care is vital in optimizing maternal and fetal outcomes.     

妊娠合并心脏病患者左室功能变化研究

目的 探讨妊娠合并心脏病患者左室功能变化。方法 采用彩色多普勒超声心动图对５５例妊娠合并心脏病患者,于孕２８－３２周进行左室功能测定,包括左室舒张末期内经（ＶＬＩＤｄ）、左室收缩末期内径（ＬＶＩＤＳ）左室射血分数（ＬＶＥＦ）等反映左 室收缩功能的指标,以及二尖瓣下舒张早期育孕峰（Ｅ）、舒张晚期充孕峰（Ａ）及其比值等反映左室舒张的指标。按ＮＹＨＡ心功能分级法,心功能Ⅰ－Ⅱ级３０例,Ⅲ－Ⅳ级２５例,并     

Pregnancy complicated by maternal cardiac disease: a review of 274 patients.

The outcome of 274 viable pregnancies in 229 patients with cardiac disease that delivered at the King Fahad Hospital, Al-Khobar, Saudi Arabia, between 1982 and 1998 was reviewed. The incidence was 0.6% of deliveries. Rheumatic heart disease complicated 208 (75.9%) pregnancies, congenital heart lesion in 49 (17.9%) and the remaining 17 (6.2%) pregnancies were a miscellaneous group that included supraventricular tachycardia, ectopic beats, ischaemic heart disease and cardiomyopathies. The NYHA grading was between 1-2 in 243 (88.7%) pregnancies antenatally. Thirty-one patients developed heart failure, most commonly in the antenatal period, 29 of whom were of Grade 1-2. One mother in the series died from heart failure following a cesarean section. She had had a mitral valvotomy before pregnancy and was categorised as Grade 2, antenatally. The perinatal mortality rate was 14.6/1000 deliveries in the study group. Prophylactic antibiotics were given to all the patients an hour before delivery. There were two instances of bacterial endocarditis in the series.     

围产期心功能不全59例临床分析

目的探讨围产期心功能不全的临床相关因素。方法对北京大学人民医院1990年1月至2008年12月间收治的59例围产期心功能不全患者的临床资料进行回顾性分析。结果①围产期心功能不全以妊娠高血压性心脏病发生率最高,22例（37.29%）,其次是风湿性心脏病10例（16.95%）,先天性心脏病9例（15.25%）等;②按心功能分级,Ⅱ级17例（28.81%）,Ⅲ级22例（37.29%）,Ⅳ级20例（33.90%）;③按心功能不全发生的时间：产前发生47例（79.66%）,产时2例（3.39%）,产后10例（16.95%）;④分娩方式：剖宫产44例（74.58%）,产钳5例（8.47%）,顺产10例（16.95%）;⑤孕产妇死亡1例,围产儿死亡率2例（33.9‰）。结论59例围产期心功能不全的病因以妊娠高血压性心脏病占首位,产前发生为主,分娩方式的选择以剖宫产为主。重视产时及产后心衰的预警。     

Cushing disease with pregnancy

Pregnancy occurs rarely in patients with Cushing syndrome (CS) due to hypercortisolism. So far, about 150 cases of CS in pregnancy have been reported in the literature. We describe a 22-year-old female who presented in pregnancy with clinical features of CS. She delivered at 34 weeks of gestation and baby had transient adrenal insufficiency in the neonatal period. Mother underwent transsphenoidal surgery 1 year postpartum and on follow up she is under remission. Neonatal hypoadrenalism should be anticipated in maternal CS.     

Outcomes of pregnancy complicated by thyroid disease

AIMS: To perform a case note review of pregnancies complicated by thyroid dysfunction to determine management and therapeutic intervention in relation to pregnancy outcome. METHODS: A retrospective case note analysis of 81 ongoing pregnancies in 70 pregnant women with a history of thyroid dysfunction over a period of 5 years at the Glasgow Royal Maternity Hospital (GRMH), Glasgow, Scotland, United Kingdom. The results of thyroid function tests and whether a change in treatment was instituted were recorded. Thyroid function was assessed by standard laboratory reference ranges for free thyroxine (FT4) and thyroid stimulating hormone (TSH) in all trimesters. Other parameters were also noted. RESULTS: Medication levels needed to be increased in the hypothyroid group (45%), and decreased (38%) in the hyperthyroid group. CONCLUSION: Pregnancy outcome was good in majority of cases given appropriate replacement therapy for stated reference values.