Analysis Of Pregnancy Outcomes In Patients With Pulmonary Hypertension

Objective:To investigate the pregnancy outcomes in patients with pulmonary hypertension,the risk factors of postoperative complications and the status of diagnosis and treatment,this study retrospectively analyzed the clinical data of inpatients with pulmonary hypertension combined with pregnancy since 2010,so as to provide more evidence for clinical management of perinatal pulmonary hypertension patients.Methods:94 cases with pulmonary hypertension complicated with pregnancy were selected from October 2010 to March 2018 in Qilu Hospital of Shandong University,and the related clinical data were analyzed retrospectively.The inclusion criteria were according with the echocardiographic diagnostic criteria estimated by TI for pulmonary hypertension:pulmonary artery systolic pressure(sPAP>40mmHg).Cases with incomplete data were excluded.Results:1.The main pathogeny of the patients with pulmonary hypertension combined with pregnancy was the first major type of pulmonary hypertension,among which,67.37%was congenital heart disease,followed by idiopathic pulmonary hypertension,accounting for 16.84%.In the first group of patients with pulmonary hypertension,except for atrial septal defect,the proportion of patients with severe pulmonary hypertension was more than 50%.2.The death cases all occurred in the first group of patients with pulmonary hypertension and the majority were patients with Eisenmenger syndrome,accounting for 81.82%.3.Divided patients into two groups as with intracardiac shunt group and without intracardiac shunt group,showing that there was no significant difference in the grade of pulmonary arterial hypertension,the classification of cardiac function and the distribution of data between the two groups,and also there were no effects on the gestational age,the complications after cesarean section and the Apgar score of the newborns.However,it is worth noting that the mortality rate of with intracardiac shunt group is higher than that without shunt group(20.93%vs 5.56%),but the statistical difference is not significant(p=0.058).4.There was a statistically significant difference in the incidence of complications between different anesthetic methods during pregnancy,and the incidence of complications in general anesthesia was much higher than that of local anesthesia(73,68%vs 41.67%,p<0.05).5.Analyzing the risk factors of postoperative complications:first,the ultrasonic estimation of sPAP level was positively correlated with the incidence of complications after cesarean section(p<0.01),and the neonatal Apgar score was affected,and the incidence of asphyxia in the severe sPAP group was higher than other groups(p<0.05).Second,the level of total bilirubin was positively correlated with operative complications,that is,the higher the total bilirubin level,the higher the incidence of operative complications(p=0.001).Third,there was a significant negative correlation between the preoperative cardiac functional grading and complications,the higher the NYHA grading,the worse the cardiac function and the higher the incidence of complications(p<0.01).However,in this study,the correlation between NT-proBNP as an indicator of objective cardiac function and complications did not reach statistical significance(p=0.073).Other factors such as age,left ventricular end diastolic diameter(LVEDD),right ventricular end diastolic diameter(RVEDD),RV/LV ratio,left ventricular ejection fraction(LVEF)were not associated with operative complications.6.The pre pregnancy awareness rate of the first major pulmonary hypertension was 58.23%,of which the idiopathic pulmonary hypertension was 18.75%,the congenital heart disease pulmonary hypertension was 68.25%,and the rate of treatment for patients with pulmonary hypertension before pregnancy was only 23.91%Conclusion:Congenital heart disease is the main cause of pregnancy patients combined with pulmonary hypertension.Whether there is an intracardiac shunt does not affect the incidence of complications after cesarean section and the prognosis of neonates,but there is a high mortality trend in those patients with intracardiac shunt.Except for sPAP level,preoperative NYHA classification and anesthesia way,the serum total bilirubin level was an independent risk factor for postoperative complications and there was no correlation between age,LVEDD,RVEDD,RV/LV ratio,LVEF and the occurrence of surgical complications.The detection rate and effective treatment rate of pulmonary hypertension before pregnancy are low.Echocardiography should be added as routine examination before pregnancy.