妊娠合并大动脉炎对母儿结局的影响

Effects of pregnancy complicated with Takayasu arteritis on maternal and fetal outcomes

目的探讨妊娠合并大动脉炎(TA)对母儿结局的影响。方法回顾性分析2012年1月至2020年12月郑州大学第一附属医院收治的17例TA合并妊娠并最终终止妊娠患者的临床资料和母儿结局。结果17例TA患者的24例次妊娠中,初产11例次(46%,11/24),经产13例次(54%,13/24);妊娠前慢性高血压4例次(17%,4/24),非高血压20例次(83%,20/24)。TA分型中,头臂动脉型15例次(63%,15/24)、广泛型8例次(33%,8/24)、肺动脉型1例次(4%,1/24),无胸腹动脉型;其中广泛型中累及肾动脉者7例次(7/8)。17例TA患者的24例次妊娠中,发生妊娠并发症8例次(33%,8/24),其中子痫前期4例次(17%,4/24),妊娠期新发的高血压、原有的高血压加重、血小板减少、脑梗死各1例次(4%,1/24);人工流产3例次,引产1例次,最终分娩20例次。最终分娩的20例次中,阴道分娩3例次(15%,3/20),剖宫产术分娩17例次(85%,17/20);胎儿生长受限3例次(15%,3/20),羊水过少6例次(30%,6/20)。20例新生儿中,17例(85%,17/20)为足月产,3例(15%,3/20)为早产,中位终止妊娠孕周为38.4周(范围:29.6~40.9周),其中早产者均并发子痫前期或重度子痫前期,且均因并发症导致早产;新生儿出生体重为(2791±783)g;发生新生儿窒息3例(15%,3/20),入住新生儿重症监护病房者6例(30%,6/20),无新生儿死亡。随访3个月~7年,除1例患者产后3年因TA行手术治疗,术中大出血死亡外,其余患者均病情稳定;所有子代均生长发育良好。存在慢性高血压、累及肾动脉、妊娠期未应用激素和阿司匹林孕妇的母儿不良事件发生率较高,但分别比较,差异均无统计学意义(P均>0.05)。结论妊娠合并TA对母儿结局存在不良影响。妊娠前应充分评估TA患者病情,妊娠期需要多学科合作,规范治疗,加强病情监护,及时处理并发症,选择合适的分娩方式,警惕产后严重并发症的发生,从而减少母儿不良事件的发生。

Objective To explore the effects of pregnancy complicated with Takayasu arteritis(TA)on maternal and fetal outcomes.Methods The clinical data of 17 TA patients with pregnancy and finally terminated admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2020 were collected and the maternal and infant outcomes were retrospectively analyzed.Results Among the 24 pregnancies in 17 TA patients in our hispital,11 patients in our hospital were primiparous(46%,11/24)and 13 patients were multiparous(54%,13/24);4 cases of chronic hypertension before pregnancy(17%,4/24),and 20 cases of non-hypertension(83%,20/24)were abserved.Apart from the thoracoabdominal artery type,15 cases(63%,15/24)of brachiocephalic type,8 cases(33%,8/24)of extensive type,and 1 case of pulmonary artery type(4%,1/24)were included in TA classification;the renal artery was damaged in 7 cases(7/8)of the extensive type.Among the 24 pregnancies of 17 TA patients,8 cases of pregnancy complications occurred,including 4 cases(17%,4/24)of preeclampsia,one case of(4%,1/24)new-onset hypertension during pregnancy,exacerbation of existing hypertension,thrombocytopenia and ischemic stroke respectively;3 cases of induced abortion,1 case of induced labor,and 20 cases of final delivery were found.Of the 20 final deliveries,3 cases(15%,3/20)were delivered through the vagina;17 cases(85%,17/20)were delivered by cesarean section;3 cases(15%,3/20)of fetal growth restriction and 6 cases of oligohydramnios(30%,6/20)were occurred.The median gestational age of pregnancy termination of 17 full-term neonates(85%,17/20)and 3 premature neonates(15%,3/20)was 38.4 weeks(range:29.6-40.9 weeks).All premature women were complicated with pre-eclampsia or severe pre-eclampsia,which lead to premature birth;the birth weight of the neonates was(2791±783)g.Neonatal asphyxia occurred in 3 cases(15%,3/20),and 6 cases(30%,6/20)were admitted to the neonatal intensive care unit.None of the newborns died.The patients were followed up for 3 months to 7 years.Except for one case who underwent surgical treatment 3 years after delivery and died of intraoperative hemorrhage,the other 16 patients were in stable condition;all the newborns grew and developed well.The incidences of maternal and infant adverse events were higher in those with chronic hypertension,renal artery involvement,and no use of hormones and aspirin during pregnancy,but the differences were not statistically significant(all P>0.05).Conclusions Pregnancy with TA has adverse effects on maternal and infant outcomes.To reduce the occurrence of maternal and child adverse events,the condition of TA patients should be fully assessed before pregnancy,multidisciplinary cooperation,regular treatment,strengthened monitoring of the condition,timely treatment of complications,selection of appropriate delivery methods after pregnancy,and vigilance of postpartum complications should be properly carried out.