背景:妊娠肺动脉高压(PAH)是主要的产科并发症之一,被认为是妊娠的禁忌症,因为它在世界卫生组织修订的妊娠风险分类中被归类为IV级风险。怀孕,具有适应性和预期的机械和荷尔蒙变化,对孕妇的心肺循环产生负面影响。单纯性先天性心脏病(CHD)修复患者在妊娠期间是否会出现其他肺部和心脏并发症?突发性肺动脉高压的孕妇能否得到及时治疗和管理?我们介绍一例39岁女性,在妊娠33周行剖宫产,并继发于单纯CHD修复后发生PAH.我们的研究始于PubMed搜索“肺动脉高压”和“怀孕”和“冠心病”病例报告。选择3例患者在纠正CHD缺陷后妊娠复查PAH。对这些研究进行了回顾,再加上我们自己的临床经验。
方法:这里,一名妇女在34岁时接受了房间隔缺损修补术,五年后怀孕,在妊娠晚期因急性外周水肿症状而突然出现PAH和右心衰竭。因此,该患者接受了剖宫产手术,并生下了健康的双胞胎。剖宫产后三天内,她的心功能随着肺动脉压的升高而恶化。有效的产后管理,包括利尿,显著的氧气吸收,血管扩张剂,容量和抗凝剂管理,导致心脏功能和氧合的改善。患者出院,恢复稳定,并转移到当地医院进行进一步的PAH治疗。
结论:该病例提醒产科医生注意冠心病修复后妊娠的重要性。对冠心病患者进行早期矫正至关重要。建议医生不要忽视双胎妊娠的水肿。此外,为进一步规范产前工作提供参考,全球冠心病患者的产时和产后管理。
BACKGROUND: Pulmonary arterial hypertension (PAH) in pregnancy is one of the major obstetric complications and is considered a contraindication to pregnancy as it is classified as a class IV risk in the revised risk classification of pregnancy by the World Health Organisation. Pregnancy, with its adaptive and expectant mechanical and hormonal changes, negatively affects the cardiopulmonary circulation in pregnant women. Do patients with repaired simple congenital heart disease (CHD) develop other pulmonary and cardiac complications during pregnancy? Can pregnant women with sudden pulmonary hypertension be treated and managed in time? In this paper, we present a
case of a 39-year-old woman who underwent cesarean section at 33 wk\' gestation and developed PAH secondary to repaired simple CHD. Our research began by a PubMed search for \"pulmonary hypertension\" and \"pregnancy\" and \"CHD\"
case reports. Three cases were selected to review PAH in pregnancy after correction of CHD defects. These studies were reviewed, coupled with our own clinical experience.
METHODS: Herein, a
case involving a woman who underwent atrial septal defect repair at the age of 34, became pregnant five years later, and had a sudden onset of PAH and right heart failure secondary to symptoms of acute peripheral edema in the third trimester of her pregnancy. As a result, the patient underwent a cesarean section and gave birth to healthy twins. Within three days after cesarean delivery, her cardiac function deteriorated as the pulmonary artery pressure increased. Effective postpartum management, including diuresis, significant oxygen uptake, vasodilators, capacity and anticoagulants management, led to improvements in cardiac function and oxygenation. The patient was discharged from hospital with a stable recovery and transferred to local hospitals for further PAH treatment.
CONCLUSIONS: This
case served as a reminder to obstetricians of the importance of pregnancy after repair of CHD. It is crucial for patients with CHD to receive early correction. It suggests doctors should not ignore edema of twin pregnancy. Also, it provides a reference for the further standardization of antenatal, intrapartum and postpartum management for patients with CHD worldwide.