| Objective:To compare the pregnancy outcomes of pregnant patients with different severity of pulmonary arterial hypertension(PAH).To explore the high risk factors of increasing the in-hospital mortality of patients with severe pulmonary hypertension.To provide a basis for clinical work to assess the patient’s condition and develop treatment plans.Methods:Total of 140 patients with pregnancy in pulmonary arterial hypertension were selected who terminated their pregnancy at Qilu Hospital of Shandong University from 2013.1 to 2018.12.(1)According to the pulmonary systolic pressure under cardiac color Doppler ultrasound,pregnancy patients with PAH were divided into three groups.Patients whose pulmonary systolic pressure was 30*-49mmHg were in mild PAH group,50-79mmHg in moderate PAH group,and≥80mmHg in severe PAH group.To analyse the effects of different pulmonary hypertension on maternal and fetal outcomes,this research compared the different characteristics of three groups,such as the causes of the three groups,cardiac function grading,BNP values,anesthesia,postoperative ICU rate,mortality and so on.(2)The patients with severe PAH who died in the hospital in the severe pulmonary hypertension group were designated as the death group,and the patients discharged safely were designated as the survival group.Compare the differences between the two groups in terms of gestational age,pathogenesis,cardiac function grading,BNP values,ECG indicators,and whether Eisenmenger syndrome occurred.Apply statistical principles to select factors that may have a greater impact on the grouping and verify their reliability,to determine the risk factors for increasing in-hospital mortality.Results:1.Comparison of mild,moderate and severe groupsOf the 140 pregnant women with PAH included in the study,39(27.85%),42(30%)and 59(42.14%)were in mild,moderate and severe groups respectively.Nine people died in hospital,with a mortality rate of 6.43%.The incidence of congenital heart disease was 46.15%,45.24%and 74.58%respectively.Sever group was more than mild and moderate group and has significant difference(P<0.05),but there was no significant difference between mild and moderate groups(P>0.05).There was no significant difference in the proportion of connective tissue disease,perinatal cardiomyopathy and unexplained PAH among the three groups(P>0.05).Compared with the severity of the disease,the proportion of grade Ⅲ-Ⅳ in the three groups was 10.26%,45.24%,71.19%,and the incidence of heart failure was 15.38%,38.10%,71.19%,respectively.The above two groups were severe group>moderate group>mild group,and there were significant differences among the three groups(P<0.05).In severe group,26 cases(44.07%)were complicated with Eisenmanger syndrome,and the mortality rate was 23.08%.Compared with pregnancy outcomes,the abortion rates of the three groups were 2.56%,9.52%and 15.25%,respectively.The incidence of severe group was higher than that of mild group and the results were statistically significant(P<0.05).There was no significant difference in the rates of induced labor and cesarean section in mid-pregnancy(P>0.05).The preterm delivery rates were 23.77%,47.62%and 38.98%respectively.The average gestational weeks of delivery were(255.36±43.27)days,(221.31±64.55)days and(209.53±74.55)days,respectively.The results showed that the moderate and severe groups were higher than the mild groups,with statistical difference(P<0.05).There was no significant difference in cesarean section rate among the three groups(P>0.05).The transfer rates to ICU after termination of pregnancy were 10.26%,52.38%and 67.80%,respectively.There were significant differences in severe group>moderate group>mild group(P<0.05).There were 0(0.00%),1(2.38%)and 8(13.56%)deaths in the hospital.The mortality rate of the three groups was higher than that of the severe group(P<0.05),but there was no significant difference compared with that of the moderate group(P>0.05).There was no significant difference in the number of complications such as fetal growth retardation,placental abruption and postpartum hemorrhage among the three groups(P>0.05).Compared with neonatal outcomes,the survival rates of the three groups were 36 cases(92.31%),33 cases(78.57%)and 40 cases(67.80%).The survival rates of the severe group were lower than those of the mild group(P<0.05),but there was no significant difference between the moderate group and the severe group(P>0.05).The average birth weight of newborns was(2957.25±692.88)g,(2370.511685.44)g,(2387.141693.83)g,respectively.The proportion of live births transferred to neonatal intensive care unit(NICU)after birth was 19.44%,61.76%and 50.00%respectively.The results showed that the moderate and severe group were less than the mild group(P<0.05).2.Comparison of death group and group in severe PAH patientsIn severe PAH patients,there were death group(n=8)and survival group(n=51).The factors that might increase the risk of death were analyzed.After logistic single factor analysis,the factors that could be included in multivariate regression calculation were:grade IV of cardiac function,concurrent Eisenmanger syndrome,NT-proBNP>800ng/ml(the highest value of Yoden index),pulmonary artery systolic pressure>109 mmHg(the highest value of Yoden index),the right deviation of the electric axis and intraoperative general anesthesia(P<0.20).The final two factors were Eysenmenger syndrome(OR 14.661)and NT-proBNP>800ng/ml(OR 6.735)(P<0.05).The ROC curve calculation results show that the area under the curve is 0.833-(95%confidence interval:0.698-0.968),indicating that the prediction model has a high degree of discrimination.Conclusions:1.The severity of PAH is an important factor affecting maternal and infant outcomes.The incidence of abortion,premature delivery,transfer to ICU after delivery,in-hospital death,and transfer to NICU of neonates in severe PAH patients are all increased.It is not suitable for pregnancy.Once it is found that termination of pregnancy is recommended.2.When severe PAH patients complicated with Eisenmanger’s syndrome and NT-proBNP>800 ng/ml,the risk of perinatal mortality increased.Pregnancy should be terminated immediately after detection,and multidisciplinary cooperation should be carried out to avoid hospital mortality. |
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