The Effect Of Congenital Heart Disease Correction On Pregnancy Outcome Of PAH-CHD Patients Before Pregnancy

BackgroundPregnancy with pulmonary hypertension,because of its higher mortality,is called the most dangerous pregnancy.Globally,it is a difficult problem that threatens the safety of maternal life.Therefore,the relevant guidelines in the world list it as an contraindication for pregnancy.With the development and advancement of medical technology,in the past 20 years,maternal prognosis has also been significantly improved than in the past.The cause of pulmonary hypertension in pregnancy varies from region to region,but in our country,these patients are mainly seen in patients with congenital heart disease.With the improvement of medical conditions in China,patients with congenital heart disease are also more likely to be found.At the same time,with the changes in national related fertility policies in recent years,there are more and more patients with congenital heart disease-associated pulmonary hypertension.At present,there are many researches and literatures on these diseases,and this article focuses on analyzing the different effects of pre-pregnancy intervention on the outcome of pregnancy and hopes that the results of this retrospective analysis can be used in the clinical treatment of such patients,improve the pregnancy outcome and reduce the mortality rate of patients.ObjectiveTo analyze the effect of congenital heart disease correction surgery on pregnancy outcomes in pregnancy with pulmonary arterial hypertension associated with congenital heart disease(PAH-CHD).MethodsA retrospective analysis of pregnant women with PAH-CHD admitted to Shandong Provincial Hospital from August 2015 to March 2018 was made.According to whether or not the CHD has undergone surgical correction,it is divided into group A(not had correction surgery)and group B(had correction surgery).Data include type of congenital heart disease,WHO functional classification,pulmonary hypertension severity,maternal and neonatal outcome.ResultsThe group of patients with congenital heart disease with atrial septal defect ventricular septal defect-based.Cardiac function in group A was mainly in grade III,in group B was mainly in grade II,and there was significant difference in WHO-FC II between two groups(P<0.05).In the severity of pulmonary hypertension,severe pulmonary hypertension in the group A was significantly more than in the group B.A total of 8 patients died,6 patients in group A,2 patient in group B,the total mortality was 30.8%,the mortality was 50%(6/12)in group A and 14.3%(2/14)in group B,but the difference in mortality between the two groups was not statistically significant(P>0.05).1 case of stillbirth and 1 case of neonatal asphyxia(1 min after birth Apgar score 6 points)in group A,group B had no adverse outcomes neonate.There were 10 premature infants in the two groups,the overall preterm birth rate was 38.5%.There were 8 premature infants in group A(66.7%)and 2 infants in group B(14.3%).The difference in preterm birth rate between the two groups was statistically significant.(P<0.05).In term of newborn birth weight,the birth weight of newborns in group B was significantly higher than that of newborns in group A.There was a statistically significant difference in neonatal weight between the two groups(P<0.05).Conclusions1.The patient's poor pregnancy outcome is related to the severity of pre-partum pulmonary hypertension and the state of the heart function.2.Patients who had undergone heart surgery before pregnancy were considered to be superior to those who did not undergo surgery in the classification of cardiac function and pulmonary hypertension,thereby reducing the preterm and low birth weight infants.