围产期管理和妊娠期心血管疾病结局：澳大利亚单中心回顾性队列研究（2012-2021）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia Pub Date : 2025-09-01 DOI:10.1016/j.ijoa.2025.104766

E Sanderson , T Stegeman , J Elhindi , L Cope , JS Dieleman , D Pasupathy , D Tanous , J Brown

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引用次数: 0

摘要

背景：孕产妇心血管疾病（CVD）是孕产妇死亡的主要原因。CVD患者的麻醉管理数据有限。方法：这项为期10年的回顾性队列研究纳入了508例CVD孕妇，按修改后的世界卫生组织（mWHO）风险分类进行分层，将低危组（mWHO I-II）（n = 323）和高危组（mWHO II至III-IV）（n = 185）与对照产科人群（n = 55153）进行比较。主要结局是产妇死亡率和心力衰竭，次要结局包括产妇、产科、大麻醉和新生儿并发症。结果无产妇死亡，3%的产妇发生心力衰竭。高危产妇剖腹产的可能性高于对照组（P < 0.01），低危产妇剖腹产的可能性较低（P = 1.0）。两组间产后出血率差异无统计学意义（P = 0.91）。高危组早产、低Apgar评分、死胎率均高于低危组和对照组（P < 0.01, P = 0.01, P = 0.02）。母亲心脏病影响了15%的早产决定。有1例新生儿死亡（低危组，0.3%），与对照组（0.3%）相当。分娩时硬膜外镇痛是低高危人群阴道分娩的主要镇痛方式。最常见的麻醉方式是低危患者的脊髓麻醉（61%）和高危患者的脊髓硬膜外联合麻醉（31%）。主要麻醉并发症罕见（0.2%）。结论：本研究对mWHO I-IV型心血管风险妇女的围产期管理和结局进行了研究，结果显示产妇死亡率和发病率水平较低，但高危心血管疾病的一些不良结局风险增加。临床医生应该预测高危心血管疾病患者的早产风险和专科护理需求。

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Peripartum management and outcomes of cardiovascular disease in pregnancy: a single-centre retrospective cohort study from Australia (2012–2021)

Background

Maternal cardiovascular disease (CVD) is a leading cause of maternal mortality. Data on anaesthetic management in patients with CVD is limited.

Methods

This ten-year retrospective cohort study of 508 pregnancies in women with CVD, stratified by modified World Health Organization (mWHO) risk category, compared lowrisk (mWHO I-II) (n = 323) and high-risk (mWHO II to III-IV) (n = 185) groups to a control obstetric population (n = 55,153). The primary outcomes were maternal mortality and cardiac failure, secondary outcomes included maternal, obstetric, major anaesthetic, and neonatal complications.

Results

There were no maternal deaths, 3 % of patients developed cardiac failure. High risk patents were more likely to deliver by caesarean delivery (CD) than controls (P < 0.01), but low risk were not (P = 1.0). There was no difference in postpartum haemorrhage rates between groups (P = 0.91). Rates of preterm birth, low Apgar score, and stillbirth were higher in high-risk patients than low-risk and control groups (P < 0.01, P = 0.01, P = 0.02, respectively). Maternal cardiac disease influenced decision for preterm birth in 15 %. There was one neonatal death (low-risk group, 0.3 %), comparable to the control population (0.3 %). Labor epidural analgesia was the predominant mode of analgesia for vaginal deliveries in low- and high-risk groups. The most frequent modes of anaesthesia for CD were spinal anaesthesia (61 %) in low-risk and combined spinal epidural (31 %) in high-risk patients. Major anaesthetic complications were rare (0.2 %).

Conclusions

This study of peripartum management and outcomes in women with mWHO I-IV cardiovascular risk demonstrated low levels of maternal mortality and morbidity, but increased risk of several adverse outcomes in high-risk CVD. Clinicians should anticipate the risk of preterm birth and need for specialised care in high-risk CVD patients.

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来源期刊

International journal of obstetric anesthesia 医学-妇产科学

CiteScore

4.70

自引率

7.10%

发文量

285

审稿时长

58 days

期刊介绍： The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.