妊娠合并肥厚型心肌病患者的临床特征及妊娠结局

Clinical features and pregnancy outcomes of pregnant women with hypertrophic cardiomyopathy

目的分析妊娠合并肥厚型心肌病(HCM)患者的临床特征及妊娠结局。方法选取2010年1月至2018年1月于首都医科大学附属北京安贞医院住院终止妊娠的HCM患者42例,回顾性分析其孕期体格检查、辅助检查(超声心动图、心电图检查)、产科处理和结局等相关资料。结果 42例患者中梗阻型12例(28.6%),非梗阻型30例(71. 4%);美国纽约心脏病协会心功能分级Ⅰ～Ⅱ级39例(92.9%),Ⅲ～Ⅳ级3例(7. 1%);心电图以ST-T改变为主。5例(12.0%)孕早、中期终止妊娠;进入围产期37例患者中32例(76. 2%)行剖宫产术终止妊娠,5例(23. 8%)自然分娩;其中33例(89. 2%)为孕足月分娩,4例(10.8%)早产(孕28～36^(+6)周)。42例孕妇均病情稳定出院。37名围生儿均存活,未发生新生儿窒息。4名早产儿中低出生体质量儿(出生体质量<2 500 g)2名,33名足月围生儿中低出生体质量儿1名(3.0%),余32名(97.0%)为正常体质量新生儿。结论根据妊娠合并HCM孕妇情况,加强妊娠期及产褥期监护,多数患者可获得良好母儿结局。

Objective To analyze the clinieal features and pregnancy outcomes of pregnant women with hypertrophic cardiomyopathy(HCM).Methods Clinical data of 42pregnant women with HCM who delivered in Beijing Anzhen Hospital,Capital Medioal University from January 2010to January 2018were retrospectively analyzed.Physical,echocardiographie and electrocardiographic examination resuhs,obstetric treatments and pregnancy outcomes were analyzed.Result There were 12cases (28.6%)of obstructive HCM and 30cases (71.4%)of non-obstructive HCM;39cases of New York Heart Association cardiac function grading Ⅰ~Ⅱ and 3cases(7.1%)of grading Ⅲ~Ⅳ.Electrocardiogram showed ST-T changes in most patients.Five patients (12.0%)had termination of a pregnancy during the first or second trimester;32patients(76.2%)had cesarean section and 5patients(23.8%)had natural delivery;33patients (89.2%)had full-term delivery and 4patients (10.8%)had premature delivery(28-36+6gestational weeks).All 42patients recovered well.All 37newborns survived and no neonatal asphyxia occurred.Two premature infants had low birth weight (<2500g).One full-term infant(3.0%)had low birth weight.Conclusion Pregnant women with HCM can get a good maternal and child outcome after optional intervention during pregnancy and puerperium.