心脏病患者妊娠期和产褥期的心血管、产科和围产期不良事件

IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
N.E. Guzmán-Delgado , C.E. Velázquez-Sotelo , M.J. Fernández-Gómez , L.G. González-Barrera , A. Muñiz-García , V.M. Sánchez-Sotelo , P. Carranza-Rosales , A. Hernández-Juárez , J. Morán-Martínez , V. Martínez-Gaytan
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引用次数: 0

摘要

背景和目的妊娠期心血管变化会带来更大的心脏病风险。我们分析了妊娠期和产后与先天性和获得性心脏病相关的心血管、产科和围产期不良反应。材料和方法横断面和回顾性研究,包括 2017-2023 年登记的诊断为先天性或获得性心脏病住院的妊娠期或产后患者。将不良事件(心力衰竭、中风、急性肺水肿、产妇死亡、产科出血、早产和围产期死亡)与临床变量和实施的治疗进行了比较。结果共纳入 112 名患者,中位年龄为 28 岁(15-44 岁不等)。短路患者占 28 例(25%)。39例(34.8%)发生心力衰竭,12例(10.7%)发生急性肺水肿,2例(1.8%)中风,5例(4.5%)产妇死亡,4例(3.6%)产科出血,50例(44.5%)早产,6例(5.4%)围产期死亡。分流与早产有关(调整后的几率比为 4;95% CI:1.5-10,P = .006)。围产期心肌病导致肺水肿(调整后 OR 34;95% CI:6-194,P = .001)和心力衰竭(调整后 OR 16;95% CI:3-84,P = .001)的风险较高。人工瓣膜患者(调整后 OR 30;95% CI:1.5-616,P = .025)和使用乙酰水杨酸的患者(调整后 OR 14;95% CI:1.2-16,P = .030)发生产科出血的风险增加。此外,后者与围产期死亡有关(调整后 OR 9;95% CI:1.4-68,P = .021)。结论心脏病患者在妊娠期和产后会出现严重的并发症,因此孕前评估和密切监测至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Eventos adversos cardiovasculares, obstétricos y perinatales en el embarazo y puerperio en pacientes cardiópatas

Background and objectives

Cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum.

Materials and methods

Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalized with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric hemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment.

Results

112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk.

Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric hemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, P = .006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, P = .001) and heart failure (adjusted OR 16; 95% CI: 3-84, P = .001). An increased risk of obstetric hemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, P = .025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, P = .030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, P = .021).

Conclusions

Severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.

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来源期刊
Revista clinica espanola
Revista clinica espanola 医学-医学:内科
CiteScore
4.40
自引率
6.90%
发文量
73
审稿时长
28 days
期刊介绍: Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI). The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Nine issues are published each year, including mostly originals, reviews and consensus documents.
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