妊娠合并肥厚型心肌病围产期管理13例分析

Clinical analysis of 13 cases of perinatal management of hypertrophic cardiomyopathy during pregnancy

目的探讨妊娠合并肥厚型心肌病的临床特点,妊娠风险评估及围产保健管理方式。方法对2010年1月至2020年10月收治于福建医科大学附属第一医院的13例妊娠合并肥厚型心肌病患者的临床诊治资料进行回顾性分析。结果13例中妊娠前诊断8例(61.54%),病程为孕前(3.87±2.53)年;妊娠后诊断5例(38.46%),诊断孕周(24.69±10.99)周,其中孕中期诊断3例、孕早期诊断2例。梗阻性肥厚型心肌病5例(38.46%),非梗阻性肥厚型心肌病8例(61.54%)。13例患者无孕产妇死亡,11例获得活产儿(其中2例为早产儿),2例胎儿丢失(其中1例为无生机儿,1例为死产、胎儿畸形)。母儿并发症与患者年龄、肥厚型心肌病确诊时间无关(P>0.05),与肥厚型心肌病临床类型及围产保健机构级别显著相关(P<0.05)。结论妊娠合并肥厚型心肌病为严重的妊娠合并症,重视孕前咨询及妊娠风险评估、围产期管理,在相应级别的医疗机构进行规范评估及治疗,有助于改善母儿预后。

Objective To study the clinical characteristics of hypertrophic cardiomyopathy in pregnancy,and explore pregnancy risk assessment and perinatal care management.Methods The clinical data of 13 cases of pregnancy complicated with hypertrophic cardiomyopathy who deliveried in the First Affiliated Hospital of Fujian Medical University from January 2010 to October 2020 were restrospectively analyzed.Results Eight cases(61.54%)were diagnosed before pregnancy,and the mean course of disease was(3.87±2.53)years before pregnancy;five cases(38.46%)were diagnosed after pregnancy,and the gestational age of diagnosis was(24.69±10.99)weeks,among which three cases were diagnosed in the second trimester and two cases in the first trimester.There were 5 cases of obstructive hypertrophic cardiomyopathy(38.46%)and,eight cases(61.54%)of non-obstructive hypertrophic cardiomyopathy.There were thirteen cases with no maternal death,eleven cases with live births(2 of them premature),and two cases with fetal loss(one was lifeless and the other was stillbirth with fetal malformation).The incidence of maternal and infant complications was not related to age or diagnosis time of hypertrophic cardiomyopathy(P>0.05),but was significantly related to the clinical type of hypertrophic cardiomyopathy and the level of perinatal health care institution(P<0.05).Conclusion Hypertrophic cardiomyopathy during pregnancy is a serious complication of pregnancy,pregnancy risk assessment and perinatal management of patients with this disease should be paid attention to,and standardized assessment and treatment in corresponding medical institutions can help improve the prognosis of mothers with this ObjectiveTo study the clinical characteristics of hypertrophic cardiomyopathy in pregnancy,and explorepregnancy risk assessment and perinatal care management.MethodsThe clinical data of 13 cases of pregnancycomplicated with hypertrophic cardiomyopathy who deliveried in the First Affiliated Hospital of Fujian MedicalUniversity from January 2010 to October 2020 were restrospectively analyzed.ResultsEight cases(61.54%)werediagnosed before pregnancy,and the mean course of disease was(3.87±2.53)years before pregnancy;five cases(38.46%)were diagnosed after pregnancy,and the gestational age of diagnosis was(24.69±10.99)weeks,among which three caseswere diagnosed in the second trimester and two cases in the first trimester.There were 5 cases of obstructive hypertrophiccardiomyopathy(38.46%)and,eight cases(61.54%)of non-obstructive hypertrophic cardiomyopathy.There werethirteen cases with no maternal death,eleven cases with live births(2 of them premature),and two cases with fetal loss(one was lifeless and the other was stillbirth with fetal malformation).The incidence of maternal and infantcomplications was not related to age or diagnosis time of hypertrophic cardiomyopathy(P>0.05),but was significantlyrelated to the clinical type of hypertrophic cardiomyopathy and the level of perinatal health care institution(P<0.05).ConclusionHypertrophic cardiomyopathy during pregnancy is a serious complication of pregnancy,pregnancy riskassessment and perinatal management of patients with this disease should be paid attention to,and standardizedassessment and treatment in corresponding medical institutions can help improve the prognosis of mothers with this disease and children.