Clinical Analysis Of77Cases In Women With Congenital Heart Disease

Objective:Research on the predictors of maternal and neonatal adverse outcomes associated with pregnancy in women with congenital heart disease.Methods:Clinical data of77pregnant women between Jan2002to Dec2012with congenital heart disease were analyzed retrospectively, Then analysis of the basic data of the51patients (66.2%) collected by phone call follow-up.Results:1.General data:77patients, consist of64primipara and13multiparous,12underwent pregnancy termination wth gestational ages before20weeks,of which4because of the poor NYHA functional class(Ⅲ-Ⅳ),8elective abortions.A total of70births(1double gestation), weight1120.00-4100.00g, average (2819.24617.75)g.2.Type of the CHD:VSD is the most common form CHD (41.2%), followed by ASD(19.6%), patent ductus arteriosus (7.8%), ventricular septum aneurysm (7.8%), pulmonary valve stenosis (5.9%).3.Adverse events:The cardiac events during pregnancy occurred in28pregnancies (54.9%);31(60.8%) women suffering a later cardiac event. Clinically significant (requiring treatment) episodes of arrhythmia or heart failure,accounts for all the cardiac events.Obstetric complications occurred in17(33.3%) patients, the most important obstetric complications were premature(17.65%)and hypertension-related disorders(15.69%).Adverse neonatal complications occurred in19cases (37.3%),The most frequently encountered offspring outcomes were premature delivery(17.65%) and born small for gestational age(17.65%),followed by FGR, neonatal asphyxia,both with an incidence of7.84%.4.Mode of delivery:Cesarean section as the major delivery mode accounts for86.3%(n=44) of total delivery,75%(n=33) as social factors, followed by6cases(13.6%)cardiac factors.11.4%(n=5)because of the obstetric factores, with severe preeclampsia(n=2),HELLP syndrome(n=2) and fetal distress(n=1).1in7patients with spontaneous delivery I°laceration of perineum,2left side routine perineal suturing.5.The risks of the adverse events:5.1The probability of cardiac events during pregnancy of the NYHA I group before pregnancy is0.062times of the NYHA Ⅲ patients. According to the level of the pulmonary artery pressure For the lower group the probability of the Cardiac events occurred during pregnancy is0.162times of the adjacent higher ranking patient.5.2The probability of the obstetric complications of the NYHA I group before pregnancy is0.062times of the NYHA II patients.According to the level of the pulmonary artery pressure For the lower group the probability of the obstertric events occurred during pregnancy is0.318times of the adjacent higher ranking patient.5.3The probability of the neonatal events of the NYHA I group before pregnancy is0.080times of the NYHA II patients,for the NYHA II patients the presence of the Maternity risk factors make the incidents of the offspring events higher than the non-maternity risk group(P<0.05).5.4The probability of the LCE of the NYHA I group before pregnancy is0.163times of the NYHA II patients.A total of14patients (27.5%)appeared deterioration of cardiac function compared with pre-pregnancy at the time of follow-up, pre-pregnancy cardiac function grade I declined to NYHA Ⅱat the time of follow up in10cases(32.3%),pre-pregnancy cardiac function grade Ⅱ declined to NYHA III at the time of follow up in2cases,2cases of death for the reason of cardiac failure, both of them did not undergone surgical treatment.Conclusion:1.Pregnancy in women with congenital heart disease is associated with significant cardiac,obstetric and neonatal complications.2.Cardiac failure,cardiac arrhythmia that need treatment accounted for most of the cardiac events; premature and hypertension-related disorders is the most common form obstetric events; The most frequently encountered offspring outcomes were premature delivery and born small for gestational age.3.Maternal pre-pregnancy NYHA functional class and pulmonary hypertension is the predictors of the cardiac events during pregnancy; Maternal pre-pregnancy NYHA functional class and pulmonary hypertension is the predictors of the obstetric events; Maternal pre-pregnancy NYHA functional class is the predictors of the neonatal complications; for the Maternal pre-pregnancy NYHA functional class Ⅱ group, the deleterious effects of maternal heart disease on neonatal outcomes were amplified by the presence of concurrent obstetric risk factors.4.Maternal pre-pregnancy NYHA functional class is the predictor of the LCE,the NYHA II group has a higher incidence of LCE,especially for the patients who did not undergone surgical treatment before pregnancy.