| Objectives:To analyze the clinical data of 106 cases of pregnancy complicated with congenital heart disease(CHD)from the First Affiliated Hospital of Kunming Medical University,it provides reference opinions for the management during pregnancy,monitoring of labor process,and selection of delivery methods for pregnant women with CHD.Methods: The clinical data of 106 pregnant patients(including 6 cases which gestational age<28 weeks)with congenital heart disease who were delivered in the First Affiliated Hospital of Kunming Medical University between January 1st,2019 to December 31 th,2022 were collected.According to combine whether or not with pulmonary arterial hypertension and the degree of combination,the data were divided into the non combined with PAH group(55 cases),mild PAH group(36 cases),moderate PAH group(6 cases),and severe PAH group(9 cases)in this study.Besides,according to the condition of cardiac shunt,the clinical data were divided into three groups: non shunt group(64 cases),left to right shunt group(32 cases),and right to left shunt group(10 cases).In addition,the clinical data of 200 patients who delivered in the First Affiliated Hospital of Kunming Medical University without pregnancy complications during the same period were randomly collected as a control group.Finally,the groups were using to retrospectively analyze.Results:(1)The clinical data of the pregnant patients complicated with CHD who terminate week of pregnancy ≥ 28 compared with the control group: 1)General situation: there was no statistically significant difference in mean age(P>0.05),and there were significant differences in average height,baseline weight before pregnancy,body mass index(BMI)before delivery,average length of hospital stay,number of pregnancies,number of births,and irregular birth examination rate(P<0.05);2)Maternal and fetal outcomes: there were no statistically significant difference in the Apgar score,PH value and BE value of umbilical artery and vein at birth compared with the control group(P>0.05);The average terminate week of pregnancy was earlier than that of the control group(38.73 ± 1.96 weeks vs.39.93 ± 0.94 weeks,P<0.05),and the average birth weight of newborns was lower than that of the control group(2973.64 ± 538.15 g vs.3223.05 ± 334.93 g,P<0.05).The cesarean section rate was42.0%,and the postpartum hemorrhage rate was 12.0%,and the rate of newborns transfer to NICU was 28.0%,and the rate of puerperant transfer to ICU was 11.0%,and the incidence of SGA was 6.74% which were higher than those in the control group(P<0.05).(2)The clinical data of the pregnant patients complicated with CHD who delivered through vagina compared with the control group delivered through vagina: There were no significant difference in the length of the first,second and third stages of labor,and the use of oxytocin after delivery(P>0.05).The average amount of postpartum hemorrhage was more than that of the control group(356.90 ± 183.88 ml vs.268.96 ± 162.37 ml,P<0.05).The rate of postpartum hemorrhage(20.69%),forceps delivery(18.97%),lateral episiotomy(53.45%),newborns transfer to NICU(32.76%),and puerperant transfer to ICU(5.17%)was higher than those in the control group(P<0.05).(3)The clinical data of the pregnant patients complicated with CHD who delivered through cesarean section compared with the control group delivered through cesarean section: There were no statistically significant difference in the use of oxytocin and the rate of newborns transfer to NICU(P>0.05).The average amount of intraoperative bleeding was more than that in the control group(470.24 ± 139.28 ml vs.405.56 ± 93.76 ml,P<0.05).(4)There was no statistically significant difference in the rate of newborns transfer to NICU among pregnant women with CHD under different delivery methods(P>0.05).The incidence of postpartum hemorrhage after cesarean section was lower than that of vaginal delivery,and the rate of puerperant transfer to ICU was higher than that of vaginal delivery(P<0.05).(5)Comparing the clinical data of the pregnant patients complicated with CHD who combine whether or not with pulmonary arterial hypertension and the degree of combination: 1)General situation: There were no statistically significant difference between the four groups in mean age and the rate of palpitations during pregnancy(P>0.05),while there were statistically significant difference in the rate of irregular obstetric examination,the rate of cardiac function grades III-IV,the rate of whether surgical treatment was performed before pregnancy,and the rate of cardiac shunt(P<0.05).2)Maternal and fetal outcomes: There were statistically significant difference in the rate of fetal loss and the rate of pregnant women to ICU after delivery(P<0.05);In patients with delivery gestational weeks>28 weeks,there was no statistically significant difference in cesarean section rate among the four groups(P>0.05).The average delivery gestational weeks of severe group was earlier than that of moderate group,and earlier than that of mild group,and earlier than that of non combined group(35.54 ± 2.83 weeks vs.36.08 ± 3.61 weeks vs.38.92 ± 1.40 weeks vs.39.14 ± 1.57 weeks)(P<0.05),and the rate of newborns to NICU in severe group(100.0%)was higher than that in moderate group(60.0%),and higher than that in mild group(25.0%),and higher than that in non combined group(18.52%)(P<0.05).(6)Compared with different cardiac shunt conditions: The rate of surgical treatment before pregnancy in the right to left group(0.0%)was lower than that in the left to right shunt group(12.5%)and lower than that in the non shunt group(87.55%)(P<0.05),and the rate of puerperant transfer to ICU in the right to left shunt group(90%)was higher than that in the left to right shunt group(15.63%),and higher than in the non shunt group(1.56%)(P<0.05),and the rate of newborns transfer to NICU in the right to left shunt group(60%)was higher than that in the left to right shunt group(21.88%)and higher than that in the non shunt group(21.88%)(P<0.05),and the fetal loss rate in the right to left shunt group(30%)was higher than that in the left to right shunt group(9.38%)and higher than that in the non shunt group(0.0%)(P<0.05).Conclusions:(1)In this study,the premature delivery rate,cesarean section rate,small for gestational age incidence rate,postpartum hemorrhage rate,and postpartum hemorrhage volume under corresponding delivery methods is all higher in pregnant women with CHD.The rate of postpartum transfer to ICU and newborns to NICU after birth is higher too,and it is necessary to invite a neonatal paediatrician to accompany the delivery.(2)If pregnant women experience symptoms like palpitations,chest tightness,and dyspnea,or electrocardiogram indicates abnormalities during pregnancy,the echocardiography should be completed.If the economic level support,all pregnant women should complete echocardiography.(3)The indications of cesarean section for pregnant women with CHD may should be appropriate relaxed.During vaginal delivery,the doctors should closely monitor the progress of the labor process and the intrauterine condition of the fetus,and accomplish blood preparation,and guard against postpartum hemorrhage,and may be should relax the indications for surgical delivery.(4)When combined with moderate to severe PAH,the rate of transferring pregnant women to ICU after delivery,and the rate of transferring newborns to NICU,and the rate of cardiac function grade III-IV is higher,and the average pregnancy termination week is earlier,in this study.(5)In the severe PAH group,the rate of maternal conversion to ICU,and the rate of fetal loss,and the rate of cardiac function grade III-IV is higher than other groups.The severity of condition was related to the degree of PAH,but the doctors should pay more attention to all pregnant women with PAH instead of only focus on the pregnant women with severe PAH.(6)The proportion of adverse pregnant outcomes in right to left shunt group is the highest. |
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