| Heart diseases are the most important non obstetrical causes of maternal deaths during pregnancy in China. Approximately 0.9%-3.7% of pregnancies are complicated by cardiac disease in the developing country.The incidence of heart disease in pregnancy rates of China was 1.06%.Rheumatic heart disease (RHD) accounts for the majority of cases in China before 80 years in the 20th century. Progress in the fields of diagnostic techniques and surgical intervention has dramatically improved a longer survival and a higher quality of life in patients with congenital heart diseases (CHD), to lead to the quantity of patients with heart diseases year by year. Types of heart disease and the treatment were changed. Surgical intervention carry specific problems during pregnancy, such as the best opportunity of pregnancy, perinatal management of anticoagulation. They were't unsolved.The changes of cardiovascular physiology can impose additional load and risk on the cardiovascular system of women with heart disease during pregnancy.Hemodynamic changes pre-exist in women with cardiac disease and these of pregnancy further add to this burden, even lead to heart failure.It's report that neonatal events occurr in the pregnant women complicated the heart disease were small-for-gestational-age birthweight, premature birth, respiratory distress syndrome, intraventricular hemorrhage, and fetal or neonatal death.ObjectiveThrough the analysis of the clinical data of pregnant women with heart disease, which is based on five major teaching hosptials from Guangzhou,Shenzhen and Changsha 8 years, we analyze the chang trends of different types of heart disease and affecting factors on the outcome of prenant women with heart disease. According to the analysis of the original data, we hope to find out the exact and important information to afford the clinical evidence for the consultation and trearment of the pregnancy merger heart disease.Methods1,Data collectionThe use of retrospetive data analysis methods for the collection of the NanFang hospital, ZhuJiang hospital, the Third Affiliated Hospital of Guangzhou Medical University, the First People's Hospital of Shenzhen and Second Xiangya Hospital five three-level hosptial in January 2000 to December 2008 treated at the pregnancy was diagnosed as combined the 510 cases of cardiac disease. At the same time in the same period 100 cases of randomly selected hospital delivery is not at the normal maternal complications of pregnancy as a contral group.2,Diagnostic criteriaObstetrician comfirm pantient gestation and embryo age with diagnoses of the last menstruate, physical examination and ultrasonic check. The diagnosis standard of heart disease rest on a carefully obtained history and examination, electrocardiography and echocardiography, stemite and computerized tomography by physicians. The patients were classified into four groups according to the New York Heart Association (NYHA) functional classification. The diagnosis standard of preeclampsia, premature delivery, fetal death and fetal growth restriction are in accordance with the seventh publication of Obsterics and Gynecology which Lejie to edit in chief. Obstetrician and paediatrician give the diagnoses of embryo and baby.3,MethodThrough collect and analyse the cases of pregnant patient with heart disease, to know the incidence and the change of the types of heart disease in five hospitals. Compare different types of heart disease, pre-pregnancy treatment, and cardiac function during pregnancy, pregnancy complications, a variety of effects on maternal and child outcomes; the use of anticoagulants during pregnancy. To analyse this data to retrieval the related high risk factor of severe factors on the outcome of prenant women with heart disease.4,Statistical analysisApplication of SPSS 13.0 statistical software for statistical analysis, and tabulation and graphics by Excel 2003, P<0.05 indicated statistical significance. Numerical data as mean and standard deviation, and use the two-sample T-test Categorical data were expressed as number and percentage, and use the x2-test.Results1.The incidence about pregnant women with heart disease and heart type distributionThe incidence of heart disease in pregnancy is 0.57%. RHD is the most frequent (37.84%), CHD is the second most frequent heart disease (25.68%), arrhythmia in the pregnant patient is the third (20.21%)2. Maternal outcome 2.1 Maternal complications observed during pregnancyCardiac complication was was composed of congestive heart failure (25.09%), arrhythmia(8.57%) and Primary artery hypertension (6.94%). Obstetric complication was composed of preterm delivery (20.61%), pregnancy induced hypertension (14.9%), The incidence about infection was 11.02%. The maternal mortality rate was 1.76%.2.2 Maternal outcome in pregnancy women with heart disease according to NYHA classificationThere was no maternal dead in the NYHA stageâ… -â…¡groups.The maternal mortality (x2=5360,P=0.021) were significantly difference in the NYHA stageâ…¢-â…£groups(P< 0.05). There were significant difference in heart failure morbidity (x2=79.902, P=0.000) between the NYHA stageâ… -â…£groups and the normal pregnancy control group (P<0.05).2.3 Maternal outcome in pregnancy women with heart disease according to the type of cardiac diseaseThere was significant difference in the incidence about complication (x2=59.539,P=0.000) between RHD, CHD, heart disease induced by hypertensive disorders in pregnancy and arrhythmia (P<0.05). The heart failure were composed of heart disease induced by hypertensive disorders in pregnancy (46.09%) and RHD (40.63%). There were no significant difference in maternal mortality (x2=2.400, P=0.494) between RHD, CHD, heart disease induced by hypertensive disorders in pregnancy and peripartum cardiomyopathy(P>0.05).2.4 Comparision of maternal outcome in operation group and non-operation group2.4.1 Comparision of maternal outcome with CHD pregnancy women in operation group and non-operation groupThere were no significant difference in NYHA classification (x2=1.108,P=0.293) between operation group and non-operation group(P> 0.05). There were no significant difference in the incidence about cardiac complication (x2=0.523, P=0.470) and obstetric complication (x2=0.026, P=0.871) between operation group and non-operation group (P<0.05). There were no significant difference in maternal (x2=0.000,P=0.100) between operation group and non-operation group (P>0.05).2.4.2 Comparision of maternal outcome with RHD pregnancy women in operation group and non-operation groupThe cardiac function of heart disease was significantly improved (x2=8.532, P=0.003) in operation group (P<0.05). There were significant difference in the incidence about cardiac complication (x2=26.155,P=0.000) and obstetric complication (x2=4.442, P=0.035) between operation group and non-operation group (P<0.05). There were no significant difference in maternal (x2=0.000,P=0.100) between operation group and non-operation group (P>0.05).3. Fetal outcome3.1 Fetal complications observed during pregnancyFetal complications was was composed of premature infant (17.34%), FGR (10.00%) and neonatal asphyxia (7.14%). The fetal mortality rate was 1.43%.3.2 Fetal outcome in pregnancy women with heart disease according to NYHA classificationThere were significant difference in birth weight (x2=86.109,P=0.000),Apgar score (x2=69.857,P=0.000), premature infant (x2=71.816,P=0.000), fetal growth restriction (x2=53.081,P=0.000) between the NYHA stageâ… -â…£groups and the normal pregnancy control group (P<0.05). There was no fetal dead in the NYHA stageâ… -â…¡groups. There were no significant difference in perinatal mortality (x2=3.195,P=0.074) between the NYHA stageâ…¢and the NYHA stageâ…£(P> 0.05).3.3 Comparision of maternal outcome in operation group and non-operation group3.3.1 Comparision of fetal outcome with CHD pregnancy women in operation group and non-operation groupThere were no significant difference in birth weight (T=0.514, P=0.608),Apgar score (T=414, P=0.680), premature infant (x2=0.004,P=0.949), fetal growth restriction (x2=0.102,P=0.749), neonatal asphyxia (x2=0.070,P=0.791) between operation group and non-operation group(P>0.05).3.3.2 Comparision of fetal outcome with RHD pregnancy women in operation group and non-operation groupThere were no significant difference in birth weight (T=1.601, P=0.111),Apgar score (T=0.608, P=0.544) between operation group and non-operation group(P> 0.05).There were significant difference in premature infant(x2=5.143, P=0.023), fetal growth restriction (x2=4.208, P=0.040) between operation group and non-operation group(P<0.05). There were no significant difference in neonatal asphyxia (x2=2.335, P=0.126) between operation group and non-operation group(P>0.05).4. Pregnancy after cardiac operation and the treament of warfar in during pregnancyThe average time of postop with CVR,PBMV,CHD repaired were 4.83 years, 6.56 years and 9.35years respectively. The average warfarin dose was 2.764mg/d. There was none of the malformation induced by warfarin in pregnant women with CVR.5. Cardiac Surgery during PregnancyThere were 9 prgnant women underwent surgical treament. There were 4 PBMV,2 MVR,2 cardiac pacemaker and 1 Acute myocardial infarction. There were one maternal dead and one fetal cerebral palsy.Conclusion1.The incidence of heart disease in pregnancy is 0.57%, RHD,CHD, Arrhythmia are the most frequent.2. The maternal mortality rate was 1.76%.The obstetric complication were preterm delivery and eclampsism;the cardiac complication were congestive heart failure and arrhythmia in the mother of heart disease during pregnancy. The fetal mortality rate was 1.43%.The fetal complication were premature infant,FGR and newborn asphyxiation.3.The incidence of PPCM and Eisenmenger's syndrome was lower, but the maternal mortality was higher. With surgical indications of heart disease, especially RHD surgery as possible before pregnancy, can significantly improve the outcome of maternal and fetal.4. The average warfarin dose lower 5mg/d was safe during prgnancy and lactation.5. Cardiac Surgery is the method of emergency treatment during Pregnancy when the medicine is ineffective. |
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