Retrospective Analysis 116 Cases Of Pregnancy Complicated With Pulmonary Hypertension During Perioperative Period

Objective: 1.To investigate the distribution and the prognosis of 116 cases of pregnancy complicated with pulmonary hypertension in our hospital.2.To explore factors effecting on perinatal prognosis in patients with pregnancy complicated with pulmonary hypertension.3.To explore the factors related to the occurrence of heart failure during perioperative period of pregnancy complicated with pulmonary hypertension.Methods: 1.From January 2006 to December 2016,patients who were treated with Pulmonary Hypertension(PH)in our hospital were retrospectively analyzed.The relevant clinical data were analyzed and statistically analyzed.2.The initial screening medical records considered high-pressure pulmonary diagnostic criteria,as echocardiography in pulmonary artery pressure> 30 mm Hg,namely(Definition of pulmonary hypertension: The current hemodynamic systolic PAP greater 30 mm Hg).3.The tricuspid regurgitation Doppler pulmonary artery pressure was utilized as estimated values,as well as the clinical manifestations,etiology,color Doppler ultrasound cardiac and pulmonary hypertension findings were graded: mild(s PAP:30~50mm Hg)?moderate(s PAP:50~70mm Hg)?severe(s PAP:>70mm Hg);and classification :(1)pulmonary arterial hypertension PAH?(2)pulmonary hypertension with left heart disease PH-LHD?(3)pulmonary hypertension associated with lung disease?(4)pulmonary hypertension due to chronic thrombotic and /or embolic disease CTEPH?(5)miscellaneous.The clinical data was analysis of pregnancy in patients with pulmonary hypertension to study the influencing factors on perinatal outcome.4.According to the diagnostic criteria for heart failure gestation,pregnant women with pulmonary hypertension were selected into further heart failure analysis.Results: 1.From January 2006 to December 2016,116 individuals aged 18 to 44 years(mean age 29±6 years)with pulmonary hypertension were clinically diagnosed according to the above criteria.2.Pulmonary hypertension etiologies in pregnancy patients classified into 5 groups: Group 1 PAH 43 cases(37%),including idiopathic PAH 1 case,associated with PAH 42 cases: systemic lupus erythematosus 6 cases(5.2%)?congenital heart disease 36(31.0%)(tetralogy Fallot,ventricular septal defects,atrial septal defect,patent ductus arteriosus,etc.);Group 2 pulmonary hypertension with left heart disease 27 cases(23.3%),including 22 cases(19.0%)of rheumatic heart comprising disease(mitral stenosis,valvular joint disease)?systolic dysfunction related diseases in 2 cases(1.7%),and 3 cases of diastolic dysfunction related diseases(2.6%);Group 3 associated with lung disease and / or hypoxemia-related PAH 2 cases(1.7%),including 1 case of chronic obstructive pulmonary disease,1 case of bronchial pneumonia;Group 4 due to chronic thrombosis and / or embolism PAH(CTEPH)0 cases;Group 5 44 cases(37.9%)of miscellaneous,including 3 cases(1.6%)of thyroid disease(2 cases of hyperthyroidism,hyperthyroidism heart disease in one case)?7 cases of abnormal glycogen metabolism(6.0%)(gestational diabetes mellitus 6 cases,one case of impaired glucose tolerance)?hemoglobin disease in 6 cases(5.2%)(2 cases of thalassemia,3 cases of anemia,1 case of laplastic anemia)?perioperative myocardial disease(n = 1,0.9%)?glomerulonephritis(n = 1,0.9%)?and other factors are unknown mechanisms related to the disease 26 cases(22.4%).3.Factors impating perinatal prognosis in patients with PH.(1)According to the classification of PH diagnosis,compare the perinatal prognosis between the different types of PH group.The results showed that there was no significant difference in the incidence of postoperative complications(pneumonia,heart failure,neonatal asphyxia,ICU occupancy rate)between different groups(P> 0.05).(2)Comparison the perioperative prognosis of different PH pressure groups.The result showed that the occupancy rate of ICU in severe group was significantly higher than that of mild and moderate group(P <0.05),suggesting that PH pressure had an effect on perinatal heart failure and ICU occupancy rate.There was no significant difference in pneumonia and neonatal asphyxia between different PH pressure groups(P> 0.05).(3)In 116 patients with pregnancy complicated with pulmonary hypertension,there were different treatment in congenital heart disease and heart valvular disease.Then,patients were divided into surgery group and non-surgical treatment group,the length of hospital stay(LOS),incidence of heart failure,pneumonia,perinatal asphyxia(Apgar score less than 8 points)and ICU occupancy rate in two groups were not statistically significant(P> 0.05).(4)Mode of delivery and perioperative complications: termination of pregnancy in 14 cases,76 cases of cesarean section,26 cases by vaginal delivery.We compared the length of hospital stay(LOS),incidence of heart failure,pneumonia,and perinatal asphyxia(Apgar score less than 8 points)between different modes of delivery.The length of hospital stay in the cesarean section group(11.5 ± 5.8)was significantly longer than that in the normal group(5.6 ± 2.7)and the termination of the pregnancy group(7.1 ± 5.1)(P <0.05).The length of hospital stay in termination pregnancy compared to vaginal pregnancy the difference was not statistically significant.Furthermore,the incidence of heart failure and perioperative pneumonia in patients with different modes of delivery were compared,and the difference were statistically significant(P <0.01).There was no significant difference in the incidence of asphyxia between different delivery modes and perinatal children(P> 0.05).(5)Anesthesia and perioperative complications: pregnancy complicated with pulmonary hypertension in 76 patients with cesarean section,preoperative NYHA functional class on the choice of anesthesia had no effect(P> 0.05).76 cases of cesarean section,general anesthesia in 13 cases,35 cases of subarachnoid anesthesia,continuous epidural anesthesia in 28 cases.The incidence of perioperative pneumonia and heart failure,perinatal asphyxia between different anesthesia methods to compare,suggesting that the difference was statistically significant(P <0.05).4.Factors impacting survival and incidence of heart failure in perioperative period.Logistic regression analyses were evaluated with the age,fetal history,heart surgery history,PH combined with cardiac structural changes,pericardial effusion,NYAH functional class,PH combined with arrhythmia,hypoalbuminemia,anemia,PH etiologies classification,PH artery pressure,diuresis and digoxin treatment.The factors related to perioperative heart failure were: hypertension,functional class,PH artery pressure.Multivariate regression analysis were used to identify risk factors of major complication,and found that only NYAH functional class resulted in perioperative heart failure(P <0.05,OR> 1).Conclusion: 1.Pregnancies complicated with congenital and rheumatic disease are the major causes of pulmonary hypertension.2.The history of cardiac surgery,PH classification of PH had no effect on perioperative prognosis(heart failure,pulmonary infection,neonatal asphyxia,ICU occupancy rate).3.PH pressure grading affect the patient's perioperative heart failure and ICU occupancy rate,severe group need to be alert to the occurrence of perioperative heart failure in patients.The incidence of neonatal asphyxia in perioperative period(perinatal)pneumonia,heart failure and perinatal neonatal asphyxia was significantly lower than that in the cesarean section group General anesthesia group.4.The NYHA functional class is an independent risk factor for perioperative heart failure in pregnancies complicated with pulmonary hypertension.5.The mode of anesthesia have an impact on maternal and neonatal perioperative or perinatal period.