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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围产结局。方法收集1995年4月至2007年5月温州医学院附属第一医院产科收治的45例妊娠合并先心病伴肺动脉高压患者的临床资料,根据肺动脉压力情况分为轻度组29例[30～49 mm Hg(1 mm Hg=0.133kPa)],中度组8例(50～79 mm Hg),重度组8例(≥80 mm Hg),分析各组先心病的种类、心功能级别、终止妊娠孕周和方式、先心病术后妊娠的安全性以及围产结局。结果 (1)先心病种类中以房间隔缺损、室间隔缺损为主,发生率为58%(26/45)。孕前行心脏矫正手术13例(29%,13/45),以轻度肺动脉高压、心功能Ⅰ～Ⅱ级为主。(2)轻度组心功能Ⅰ～Ⅱ级者28例,中度组心功能Ⅰ～Ⅱ级者6例,重度组心功能Ⅲ～Ⅳ级者7例。(3)轻度组足月分娩27例、难免流产1例、早产1例,新生儿平均出生体重为(3153±399)g;中度组足月分娩5例,早产3例;重度组足月分娩5例,医源性终止妊娠1例,早产2例;中、重度组新生儿平均出生体重明显低于轻度组,差异有统计学意义(P<0.05),同时中、重度组胎儿结局不良。(4)妊娠合并先心病伴肺动脉高压患者的分娩方式以剖宫产分娩为主,占78%(35/45),其中轻度组剖宫产分娩22例(22/29),中度组6例(6/8),重度组7例(7/8)。(5)45例患者中有11例于孕前或产后出现心功能衰竭早期表现或心功能衰竭,均分布在中、重度组,且心功能均为Ⅲ～Ⅳ级。其中2例死亡。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,围产结局越差;孕前行心脏矫正手术后的先心病患者以轻度肺动脉高压为主,且围产结局良好;以剖宫产术终止妊娠是比较安全的分娩方式。
Objective To investigate the perinatal outcome of patients with congenital heart disease (congenital heart disease) and pulmonary hypertension in pregnancy. Methods The clinical data of 45 pregnant women with congenital heart disease complicated with pulmonary hypertension who were admitted to the First Affiliated Hospital of Wenzhou Medical College from April 1995 to May 2007 were collected and divided into mild group (n = 29) [30 ~ 49 (1 mm Hg = 0.133 kPa)], 8 cases (50-79 mm Hg) in moderate group and 8 cases (≥80 mm Hg) in severe group. The types of CHD, the level of cardiac function, the termination of pregnancy Gestational age and manner, congenital heart disease after pregnancy safety and perinatal outcome. Results (1) Atrial septal defect and ventricular septal defect were the main types of congenital heart disease, the incidence was 58% (26/45). 13 cases (29%, 13/45) received cardiac correction before pregnancy, with mild pulmonary hypertension and grade Ⅰ ~ Ⅱ cardiac function. (2) There were 28 cases with mild Ⅰ ~ Ⅱ cardiac function, 6 cases with moderate Ⅰ ~ Ⅱ cardiac function, and 7 cases with severe Ⅲ ~ Ⅳ cardiac function in severe group. (3) In the mild group, there were 27 cases of full-term delivery, 1 case of unavoidable abortion, 1 case of preterm labor, average neonatal birth weight of 3153 ± 399 g, 5 cases of full-term delivery and 3 cases of premature delivery in severe group 5 cases of childbirth, 1 case of iatrogenic termination of pregnancy and 2 cases of premature delivery. The mean birth weight of neonates in moderate and severe groups was significantly lower than that in mild groups (P <0.05) Bad ending. (4) Cesarean delivery was the main mode of delivery in pregnant women with congenital heart disease and pulmonary hypertension, accounting for 78% (35/45), of which 22 cases (22/29) were delivered by mild cesarean section, moderate group 6 cases (6/8), severe group of 7 cases (7/8). (5) Among the 45 patients, 11 cases had early signs of heart failure or heart failure before or after giving birth. They were all distributed in the moderate and severe groups, and their cardiac functions were grade Ⅲ ~ Ⅳ. Two of them died. Conclusions The higher the pulmonary pressure in patients with congenital heart disease complicated with pulmonary hypertension is, the worse the perinatal outcome is. The patients with congenital heart disease undergoing cardiac surgery before pregnancy are mainly mild pulmonary hypertension and the perinatal outcome is good. Cesarean section Termination of pregnancy is a safer delivery method.