不同先天性心脏病患者妊娠后临床特点及结局分析

Clinical characteristics and pregnancy outcomes of women with congenital heart disease

目的分析不同先天性心脏病（CHD）患者妊娠后临床特点和妊娠结局。方法入选2010年1月至2016年9月于首都医科大学附属北京安贞医院妇产科住院的CHD合并妊娠患者660例，回顾性分析不同CHD患者临床特点、妊娠结局、不良事件以及心脏并发症发生率、胎JL／新生儿并发症发生率情况。结果患者年龄16～44岁，平均（28±5）岁，入院时中位孕龄37周。围产期前终止妊娠214例，446例进入围产期，严重不良事件发生率为2．2％（10／446），产妇病死率为1．1％（5／446），心脏并发症发生率为10．3％（46／446）。无肺动脉高压的简单左向右分流型CHD以及经过手术治疗、畸形矫治满意的CHD患者妊娠风险较小，而艾森曼格综合征患者围产期出现死亡及心脏并发症的风险较高。共分娩新生儿448例，新生儿并发症的发生率为19．0％（85／448），以紫绀型复杂CHD患者所娩出新生儿的并发症发生率最高，为72．7％（8／11），新生儿心脏畸形发病率为2．9％（13／448）。结论不同CHD患者妊娠后临床结局和心脏并发症发生风险不同，无肺动脉高压的简单左向右分流型CHD以及经过手术治疗、畸形矫治满意的CHD患者可正常妊娠分娩，而艾森曼格综合征及紫绀型复杂CHD患者妊娠风险较大，建议尽早结束妊娠，提示针对不同CHD类型需要不同的监测和干预措施。

Objective To observe clinical characteristics and pregnancy outcomes in women with congenital heart disease（CHD）. Methods Totally 660 pregnant women with CHD who were admitted at Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University from January 2010 to September 2016 were retrospectively analyzed. Clinical features, pregnancy outcomes, adverse events, maternal cardiac complications and neonatal complications were analyzed. Results The average age of pregnant women was （ 28 -＋ 5 ）years （ 16-44 years） ; the median gestational age was 37 weeks （3-41 weeks）. Two hundred and fourteen women had spontaneous abortion or induced abortion before 28 gestational weeks; 446 cases had complete pregnancy. Incidence of severe adverse events was 2.2% （10/446） ; maternal mortality rate was 1.1% （5/446） ; incidence of cardiac complications was 10.3% （46/446）. Patients with simple left-to-right shunt without pulmonary arterial hypertension and corrected CHD without residual deformity had low pregnancy risk; patients with Eisenmenger＇s syndrome had high risk of maternal death and cardiac complications. In 448 newborns, incidence of neonatal complications was 19.0% （ 85/448 ） ; the incidence of neonatal complications in maternal cyanotic CHD was the highest[ 72.7% （8/11） ] ; incidence of neonatal heart malformation was 2.9% （ 13/448 ）. Conclusions There are different pregnancy outcomes and risk of cardiac complications in mother with different CHD. Patients with simple left-to-right shunt without pulmonary arterial hypertension and corrected CHD without residual deformity can have normal pregnancy and delivery; Eisenmenger＇s syndrome and cyanotic CHD can cause high pregnancy risk and early termination is recommended.