超声心动图高概率肺动脉高压孕妇的母体及围产期结局

摘要(中文译文)

本研究旨在描述在一家四级医疗中心管理的超声心动图高度提示肺动脉高压(PAH)的孕妇的母体及围产期结局,并比较有无心脏并发症(CC)女性之间的结局。这项回顾性队列研究纳入2015年至2022年间在一家转诊中心管理的超声心动图估计高度提示PAH的孕妇。临床、产科和新生儿结局均取自病历记录。CC定义为妊娠期间或产后6周内发生心力衰竭、肺水肿、心律失常、肺栓塞或孕产妇死亡。比较有无CC女性之间的结局。进行受试者工作特征(ROC)曲线分析作为探索性分析,以评估肺动脉收缩压(PASP)对CC的判别能力。共分析60名女性的62次妊娠(平均年龄24.5±6.5岁)。8次妊娠(12.9%)为选择性终止,54次(87.1%)继续妊娠。11次妊娠(17.7%)发生CC,主要为心力衰竭。记录到4例孕产妇死亡(6.5%)。在继续妊娠中,分娩时的中位孕龄为37.1周,中位出生体重为2445 g。胎儿生长受限发生率为27.7%,62.9%的分娩为剖宫产。新生儿死亡率为5.5%。在探索性分析中,PASP阈值64 mmHg预测CC的敏感性为91%,特异性为60%(曲线下面积=0.749)。肺动脉高压是妊娠期的高危状况,伴有大量母体和围产期并发症。尽管孕产妇死亡率低于类似环境下历史报告的数值,但CC的发生率仍相当可观。PASP可能反映疾病严重程度,并显示出探索性的判别能力,但需要谨慎解读。

Abstract

This study aimed to describe maternal and perinatal outcomes among pregnant women with echocardiographically high probability of pulmonary arterial hypertension (PAH) managed at a quaternary center and to compare outcomes between women with and without cardiac complications (CC). This retrospective cohort study included pregnant women with echocardiographically estimated high probability of PAH and managed at a referral center between 2015 and 2022. Clinical, obstetric, and neonatal outcomes were obtained from medical records. CC were defined as heart failure, pulmonary edema, arrhythmia, pulmonary embolism, or maternal death during pregnancy or up to 6 weeks postpartum. Outcomes were compared between women with and without CC. Receiver operating characteristic (ROC) curve analysis was performed as an exploratory analysis to assess the discriminatory ability of pulmonary artery systolic pressure (PASP) for CC. Sixty-two pregnancies in 60 women (mean age 24.5 ± 6.5 years) were analyzed. Eight pregnancies (12.9%) were electively terminated, while 54 (87.1%) continued. CC occurred in 11 pregnancies (17.7%), mainly heart failure. Four maternal deaths (6.5%) were recorded. Among ongoing pregnancies, the median gestational age at delivery was 37.1 weeks, and the median birthweight was 2445 g. Fetal growth restriction occurred in 27.7%, and 62.9% of deliveries were by cesarean section. Neonatal mortality was 5.5%. In exploratory analysis, a PASP threshold of 64 mmHg predicted CC with 91% sensitivity and 60% specificity (area under the curve = 0.749). Pulmonary arterial hypertension is a high-risk condition in pregnancy, with substantial maternal and perinatal complications. Although maternal mortality was lower than historically reported in similar settings, the incidence of CC remained considerable. PASP might reflect disease severity and shows exploratory discriminatory ability but requires cautious interpretation.

如何引用

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 的其他文献

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