妊娠合并肥厚型心肌病的围产儿结局和发生围产儿并发症的危险因素分析

Analysis of Perinatal Outcomes and Risk Factors of Perinatal Complications in Pregnanct Women with Hypertrophic Cardiomyopathy

目的:探讨妊娠合并肥厚型心肌病(HCM)患者的围产儿结局和发生围产儿并发症的危险因素。方法:回顾性分析2000年1月至2022年12月于上海交通大学医学院附属仁济医院产科心脏病监护中心收治的100例妊娠合并HCM患者的临床资料。分析纳入研究患者发生围产儿并发症的情况,包括流产、早产、小于胎龄儿、新生儿窒息、新生儿心脏畸形、围产儿死亡等发生率。采用单因素和多因素Logistic回归分析妊娠合并HCM患者发生围产儿并发症的独立危险因素。结果:①患者平均年龄为29.21±4.41岁,平均入院孕周为34.46±6.43周,有心肌病家族史16例(16%);梗阻性HCM 21例(21%),非梗阻性HCM 79例(79%);心电图检查结果异常91例(91%),主要以ST-T改变为主(77例,77%),心脏超声检查室间隔增厚平均为19.39±6.13 mm。②100例HCM患者的100次妊娠中,流产6例(6%),新生儿存活94例(94%),其中剖宫产91例(91%)、顺产3例(3%)。围产儿并发症主要为早产儿39例(39%),另外发生小于胎龄儿5例(5%)、新生儿窒息3例(3%)、新生儿心脏畸形2例(2%),无围产儿死亡。③单因素Logistic回归分析发现,孕前心功能≥Ⅱ级、左心房内径增大、合并肺动脉高压是妊娠合并HCM患者发生围产儿并发症的危险因素(OR>1,P<0.05)。多因素Logistic回归分析发现,孕前心功能≥Ⅱ级是预测妊娠合并HCM患者发生围产儿并发症的独立危险因素(OR 6.270,P<0.05)。结论:妊娠合并HCM可导致围产儿不良结局,重视妊娠合并HCM患者的风险评估及孕期管理,尽早发现危险因素,及时干预,可降低围产儿并发症的发生。

Objective:To investigate the perinatal outcomes and risk factors of perinatal complications in pregnant women with hypertrophic cardiomyopathy(HCM).Methods:A retrospective analysis was carried out on clinical data of 100 pregnant women with HCM who delivered in Obstetrical Cardiology Intensive Care Center of Shanghai Renji Hospital between Jan.2000 and Dec.2022.Analyze the incidence of perinatal complications including miscarriage,premature birth,small for gestational age infants,neonatal asphyxia,neonatal cardiac malformations and perinatal mortality.Independent risk factors of perinatal complications in pregnant women with HCM were identified using univariate and multivariate Logistic regression.Results:①The mean age was 29.21±4.41 years old,the average gestational age upon admission is 34.46±6.43 weeks.There were 16 patients with a family history of cardiomyopathy(16%),21 cases with obstructive HCM(21%)and 79 cases of non-obstructive HCM(79%),91 cases with abnormal ECG(91%),mainly with ST-T changes(77 cases,77%).The average interventricular septum was 19.39±6.13mm by echocardiography.②Among the 100 pregnancies of 100 HCM pa-tients,6 cases(6%)were miscarriages,94 newborns survived(94%),including 91 cases of cesarean section(91%)and 3 cases of vaginal delivery(3%).The predominant perinatal complications were preterm delivery(39 cases,39%),small for gestational age(5 cases,5%),neonatal asphyxia(3 cases,3%)and neonatal cardiac malformation(2 cases,2%).There were no perinatal deaths.③Univariate Logistic regression analysis showed that pre pregnancy heart function≥Grade II,increased left atrial diameter,and concomitant pulmonary hypertension were risk factors for perinatal complications in pregnant women with HCM(OR>1,P<0.05).Multivariate Logistic regression analysis found that pre pregnancy heart function≥Grade II was an independent risk factor for predicting the occurrence of perinatal complications in pregnant women with HCM(OR 6.270,P<0.05).Conclusions:HCM during pregnancy can induce poor perinatal outcome.More attention should be paid to risk assessment and pregnancy management.Early detection of risk factors can reduce the incidence of perinatal complications.