心脏瓣膜置换术及二尖瓣球囊扩张术后分娩13例分析

Analysisfor13TermDeliveriesafterCardiacValveReplacementandPercutaneousTransluminalMitralCommissuroplasty

目的：探讨心脏手术后产妇的分娩方式、抗凝剂的应用。方法：对１３例心脏手术后孕妇分娩的资料进行回顾性分析。结果：心脏手术后心功能Ⅰ～Ⅲ级，心脏手术后１年半以上可以妊娠并安全渡过孕产期；妊娠期口服华法令及分娩期应用肝素未增加母婴出血及新生儿畸形。结论：心脏瓣膜置换术者采用手术产为宜，二尖瓣球囊扩张术者以阴道分娩为宜。心脏手术后分娩前心功能达到Ⅰ～Ⅲ级、服用强心剂达到Ⅱ～Ⅲ级者，可安全分娩；妊娠期依据凝血酶原值服用抗凝剂，不增加分娩并发症。

Objective:Tostudythecardiacfunction,modeofdeliveryandanticoagulanttherapyin13pregnantwomenaftercardiacvalvesreplacement(CVR)andpercutaneoustransluminalmitralcommissuroplasty(PTMC).Method:Retrospectivedataanalysis.Results:PatientswithcardiacfunctionofdegreeItoIIcanaccomplishpregnancyanddeliverysafelyaftercardiacoperationoneandahalfyears.Usingwarfarinduringpregnancyanddeliverysafely.Usingwarfarinduringpregnancyandheparinduringdeliverydidnotincreasethebloodlossinbothmothersandneonates,andcongen-italmalformationeither.ItismoreappropriateforpregnantwomenwhohadCVRtodeliverbyce-sareansectionandthosewhohadPTMCtodelivervaginaly.Conclusions:Womenaftercardiacop-erationcanaccomplishpregnancyanddeliveryiftheircardiacfunctionbelongtodegreeI～IIwithorwithoutdigoxintreatmentbeforedelivery.Usinganticoagulanttherapycorrectlyaccordingtopro-thrombintime(PT)testduringpregnancydoesnotincreasedeliverycomplicationstobothmothersandneonates.