中期妊娠合并心脏病终止妊娠10例临床分析  

Retrospective analysis of 10 cases of pregnancy terminated during the second trimester complicated with heart disease

作　　者：丁西来[1] 金力[1] 范光升[1] 刘欣燕[1] 郎景和[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,北京100730

出　　处：《中国计划生育和妇产科》2009年第3期54-56,共3页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨中期妊娠合并心脏病的治疗及终止妊娠的方式。方法回顾分析我院2003年1月至2009年1月10例中期妊娠合并心脏病患者行治疗性引产的临床资料。结果10例中9例患者为无正规产检患者。心功能Ⅲ级～Ⅳ级5例，3例重度肺动脉高压，3例轻度肺动脉高压。心力衰竭（心衰）诱因：2例为低蛋白血症，1例为低蛋白血症合并贫血。入院后对症支持治疗改善心功能后终止妊娠，终止妊娠方式：6例行剖宫取胎术，2例利凡诺引产，1例药物引产，1例行钳刮术。其中8例恢复良好，2例死亡，死因分别为心脏右向左分流加重和肺栓塞。结论妊娠合并心脏病仍是母体死亡的重要原因。孕前咨询和定期产前检查能改善预后，对于孕中期出现心衰而无法矫正心脏畸形则宜在积极控制心衰后终止妊娠，心功能Ⅲ级～Ⅳ级或重度肺动脉高压孕20周后患者以剖宫取胎终止妊娠为佳。Objective To investigate the treatments of pregnancy complicated with heart disease and the methods of termination during the second trimester. Methods Clinical data of 10 cases of pregnant women with heart diseases terminated during the second trimester, from Jan. 2003 to Jan. 2009 was analyzed retrospectively. Results Only one pregnant woman attended systematic antena- tal visit among 10 cases. There were 5 cases of heart failure and 6 cases of pulmonary artery hypertension. Elective hysterotomy was done on six patients in 10 pregnant women. 2 cases of maternal deaths occured due to worsening right to left shunts and pulmonary em- bolism. Conclusions Pregnancy complicated with heart disease was one of the major causes of maternal mortality. Prenatal consulta- tion and systematic perinatal care can improve the outcome of the mothers. Elective hysterotomy was recommended to the patients with cardiac function class Ⅲ to Ⅳ and severe pulmonary artery hypertension after 20th weeks of pregnancy.

关 键 词：妊娠并发症 心血管 心脏病 肺动脉高压 

分 类 号：R714.2[医药卫生—妇产科学]