人工心脏瓣膜妇女的妊娠结局  

Pregnancy outcome in women wit h prosthet-ic heart valves

作　　者：Nassar A.H. Hobeika E.M. Abd Essamad H.M. 石磊 

出　　处：《世界核心医学期刊文摘（妇产科学分册）》2005年第2期24-25,共2页Core Journal in Obstetrics/Gynecology

摘　　要：This study was undertaken to evaluate the risks and preg-nancy outcome in women with prosthetic heart valves on different anticoagulent regimens.A retrospective chart re-view of 82pregnancies in 33women wit h mechanical valve prostheses at a tertiary referral ce nter from 1987to 2002.The main outcome measures were majormaternal complica-tions and perinatal outcome.The valve replaced was mitral(60.6%),aortic(18.2%),and both(21.2%).Fifty -four pregnancies(65.9%)resulted in live births,9(11.0%)had stillbirths(all on warfarin),and 12(14.6%)had spontaneous and 7(8.5%)therapeutic abortions(all on warfarin).The rate of spontaneous abor-tion was highest in women on warfarin throughout preg-nancy(P<.01).The live birth rate was higher in wom en on heparin compared with those on warfarin(P<.01),and in those on heparin /warfarin com pared with warfarin alone(P<.01).There were no maternal deaths;howe v-er,3patients had mitral valve throm bosis(2on heparin and 1on warfarin)necessitating surgery in 1patient a nd medical thrombolysis in 2patients.Hemorrhagic compli-cations occurred in 5patients,4of whom required trans-fusion.No single anticoagulant regimen confers completeprotection from thromboembolic phenomena in pregnancy.Despite a high maternal morbidity ra te,the perinatal out-come is acceptable when pregnancy pr ogresses beyond the first trimester.This study was undertaken to evaluate the risks and preg-nancy outcome in women with prosthetic heart valves on different anticoagulent regimens.A retrospective chart re-view of 82pregnancies in 33women wit h mechanical valve prostheses at a tertiary referral ce nter from 1987to 2002.The main outcome measures were majormaternal complica-tions and perinatal outcome.The valve replaced was mitral(60.6%),aortic(18.2%),and both(21.2%).Fifty -four pregnancies(65.9%)resulted in live births,9(11.0%)had stillbirths(all on warfarin),and 12(14.6%)had spontaneous and 7(8.5%)therapeutic abortions(all on warfarin).The rate of spontaneous abor-tion was highest in women on warfarin throughout preg-nancy(P<.01).The live birth rate was higher in wom en on heparin compared with those on warfarin(P<.01),and in those on heparin /warfarin com pared with warfarin alone(P<.01).There were no maternal deaths;howe v-er,3patients had mitral valve throm bosis(2on heparin and 1on warfarin)necessitating surgery in 1patient a nd medical thrombolysis in 2patients.Hemorrhagic compli-cations occurred in 5patients,4of whom required trans-fusion.No single anticoagulant regimen confers completeprotection from thromboembolic phenomena in pregnancy.Despite a high maternal morbidity ra te,the perinatal out-come is acceptable when pregnancy pr ogresses beyond the first trimester.

关 键 词：妊娠结局 人工心脏瓣膜 母体并发症 活产率 人工瓣膜 自然流产率 治疗性流产 围生期 抗凝剂 血栓栓塞 

分 类 号：R714.2[医药卫生—妇产科学]