Pregnancy Outcome And Mode Of Delivery In Pregnant Women With Congenital Heart Disease Complicated With Pulmonary Hypertension

Objective:This study through a retrospective analysis of pregnancy outcome and mode of delivery with 48 cases of patients with congenital heart disease complicated with pulmonary hypertension in order to understand the impact of pregnant with congenital heart disease complicated with pulmonary hypertension on pregnancy outcome,as well as the impact on delivery mode,so as to provide the basis for better clinical guidance.Methods:A retrospective review of 48 pregnant patients with congenital heart disease complicated with pulmonary hypertension was done from June 2012 to July 2016 to find out the congenital heart disease types,heart function distribution,gestational hypertension,heart failure,neonatal birth etc.Those patients were divided into three groups according to pulmonary hypertension,gestational hypertension,heart failure,malignant arrhythmia,neonatal birth and mode of delivery were compared among different groups,in order to analyze the effect of pulmonary artery pressure on perinatal outcome and delivery mode.Results:(1)The main types of heart disease in patients with congenital heart disease complicated with pulmonary hypertension were ventricular septal defect(VSD)and atrial septal defect(ASD),accounted for 78%,followed by patent ductus arteriosus(PDA).(2)In terms of cardiac function,in severe group,the cardiac function was worse.60% of the heart function is in grade III-IV,compared with the mild group,the difference was statistically significant(P<0.05);there was significant difference in the occurrence rate of pregnant women heart failure,preterm birth and low birth weight between patients with class III-IV cardiac function and class I–II cardiac function(P<0.05).(3)In terms of adverse cardiac events,most patients with congenital heart disease complicated with abnormal electrocardiogram,6 cases of heart failure patients with cardiac function were III-IV.There was no significant difference in the risk of hypertensive disorder between mild and moderate-severe group(P<0.05).(4)In terms of adverse obstetric events,the severe group had more preterm births,the moderate and severe group had lower birth weights,there were significant difference compared with mild group respectively(P<0.05).(5)Cesarean section is the main way to terminate pregnancy.There were no significant difference among the three groups(P > 0.05).The main way of anesthesia is spinal epidural anesthesia.Conclusion:The most type of congenital heart disease with patients is septal defect,with the pulmonary artery pressure increased,the heart function worse,the incidence rate of heart failure,premature and low birth weight infants higher.Clinicians should attach great importance to such patients,early detection of potential risks,and make appropriate preventive measures;In term of delivery,although at present most experts advocate cesarean section,but for patients with mild and moderate pulmonary arterial pressure,normal heart function and soft birth canal conditions,clinicians should help them to establish confidence in natural childbirth,pregnant women should be fully given the opportunity of vaginal delivery.