妊娠合并肺动脉高压的早期识别及管理

The Early Recognition and Management of Pregnancy with Pulmonary Hypertension

妊娠合并肺动脉高压(pulmonary hypertension)是一类严重危及母儿生命的妊娠合并症,目前任何原因引起的肺动脉高压均被列为妊娠禁忌证。孕产妇死亡多与肺动脉高压危象、右心衰竭、栓塞有关,对胎儿的影响主要包括胎死宫内、流产、早产、胎儿生长受限等。肺动脉高压妇女妊娠后,早期临床症状不典型,易与妊娠状态混淆,对早期识别提出挑战。超声心动图具有方便、简单、无创及无辐射等特性,可作为高危人群筛查手段。妊娠合并肺动脉高压一经诊断,应转至具有相关管理经验的母胎医疗中心,注重个体化管理及多学科团队协作,结合母胎情况,决定分娩时机、方式及麻醉方式,降低母儿风险,保障母婴安全。

Pregnancy with pulmonary hypertension is a life-threatening disease to both maternal and fetal.Pulmonary hypertension is currently listed as a pregnancy contraindication,no matter what the primary causes.Maternal deaths are mostly related to pulmonary hypertension crisis,right heart failure,and embolism.The main impacts on the fetus include intrauterine death,miscarriage,premature delivery,and fetal growth restriction.After pregnancy,women with pulmonary hypertension often have no obvious clinical symptoms in the early stage,and they are easily confused with pregnancy status,which poses challenges for early recognition.Echocardiography,which is convenient,simple,non-invasive and non-radiation,can be used as a screening method for high-risk populations.Once pregnant patients with pulmonary hypertension are diagnosed,they should be transferred to a maternal and fetal medicine center,with relevant management experience.Individualized management and multidisciplinary teamwork should be emphasized,and the timing,method and anesthesia method of delivery should be determined based on the maternal and fetal conditions to reduce the risks and ensure the safety.