危險評估方法有助益於懷孕及心臟病

併發症雖然顯著,然而可藉由計劃而易於管理

雖然大多數患有心臟疾病的孕婦仍能相當安適地度過懷孕期,然而在目前的醫療技術水準之下還有不少心臟及新生兒併發症存在著。根據七月三十一日Circulation: Journal of the American Heart Association的一份研究指出,有個相當簡單的危險指數能預測那些婦女發生懷孕併發症的機率。一群由Samuel C. Siu, MD,領導的加拿大籍研究人員做出這樣的結論:「我們的研究提供一個可以給予患有心臟疾病、接受產前治療的孕婦,同時評估母體與新生兒身上與懷孕相關的併發症。新生兒的死亡率是百分之二,而不足孕的分娩則更為危險;然而,心臟併發症與懷孕誘導的高血壓則較之前的報告為低。」

Risk Assessment Tool Aids Pregnancy and Heart Disease

Complications Noteworthy But Manageable With Planning

By Aman Shah, MD
WebMD Medical News

Reviewed by Michael W. Smith, MD

July 30, 2001 -- Although the majority of women with heart disease fare well during pregnancy, significant cardiac and neonatal complications still exist in spite of state-of-the-art care. But, according to research in the July 31 issue of Circulation: Journal of the American Heart Association, a relatively simple risk index can predict the level of pregnancy-related complications in these women.

"Our study provides a contemporary assessment of maternal and neonatal risk associated with pregnancy in women with heart disease who are receiving comprehensive prenatal care," conclude the Canadian researchers, led by Samuel C. Siu, MD, associate professor at the University of Toronto. "The fetal/neonatal mortality rate (2%) and rate of preterm labor (10%) was higher than that reported [previously]," whereas the rates of cardiac complications and pregnancy-induced hypertension were lower than those reported previously, say the researchers.

The researchers enrolled 562 high-risk pregnant women who had 599 completed pregnancies. At enrollment, 74% of the women had pre-existing congenital lesions, 22% had acquired heart lesions, and 4% had arrhythmias. Nearly half the women had undergone one or more surgical interventions prior to pregnancy.

A cardiac event, most commonly pulmonary edema or arrhythmia, occurred in 13% of pregnancies, while 1% were complicated by an embolic stroke or cardiac death in the mother. Neonatal complications were much more common and affected 20% of pregnancies. Premature birth and small babies were the most common complications.

Overall, there were 8 fetal deaths, and 7 neonates died from complications such as respiratory distress syndrome and intraventricular hemorrhage. In the 432 live births to women with a congenital heart disease without a known genetic syndrome, the rate of congenital heart disease in the newborn was 7%.

The researchers prepared a risk index with four components: prior cardiac event or arrhythmia, baseline NYHA class >II or cyanosis, left heart obstruction, and reduced ventricular systolic function. When they plugged in the data from their study, women who had none of these risks had a 5% chance of cardiac events, women with one risk had a 27% chance of cardiac events, and women with >1 risk had a 75% chance of cardiac events. All cardiac deaths occurred in women with >1 risk.

Women with >1 risk should be referred for cardiac interventions before they conceive and be referred to a specialized hospital afterward, while those with no described risk factors should be able to safely deliver in a nonspecialized hospital, report the authors.

"If there is any history of heart disease, obstetricians should keep cardiology in the loop -- especially in regards to blood pressure and electrical issues of the heart, because those are things we wouldn't expect them to manage," Sean Levchuck, MD, pediatric cardiologist at the Heart Center at St. Francis Hospital in Roslyn, N.Y., tells WebMD.

"Very rarely would you have a pregnant women with untreatable heart disease. There are a lot more munitions to treat things with and a lot more we can do now," he says.

Most congenital heart patients are repaired these days, but the repair may have been done 15 years ago when repair wasn't as good as it is today," he tells WebMD. "When you look at someone who is, say, 38 who had open heart surgery in 1965, you look at them differently than someone with the same lesion today," says Levchuck.

High-risk obstetricians are on the same page.

"More than 90% of women have no problem with heart disease and pregnancy. If a woman can get pregnant and has no symptoms like shortness of breath, then she should be able to go through pregnancy and have a normal vaginal delivery," says Amos Grunebaum, MD, director of clinical maternal-fetal medicine at New York Hospital-Cornell Medical Center.

"The time to change and find out whether a medication is safe during pregnancy is before they get pregnant," Grunebaum tells WebMD. "There are very few heart conditions that make pregnancy dangerous, such as pulmonary artery stenosis and problems with the aorta."

With reporting by Denise Mann

© 2001 WebMD Corporation. All rights reserved.

    
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