[Perinatal outcomes of 45 pregnant women with pulmonary hypertension complicating congenital heart disease]

Abstract

Objective: To explore the perinatal outcomes of women with pulmonary hypertension complicating congenital heart disease (CHD).

Methods: Clinical data of 45 cases of pregnant women with pulmonary hypertension complicating CHD from Apr 1995 to May 2007 were analyzed and they were divided into three groups: 29 cases of slight group [pulmonary hypertension of 30 mm Hg (1 mm Hg = 0.133 kPa) to 49 mm Hg], 8 cases of moderate group (pulmonary hypertension of 50 mm Hg to 79 mm Hg) and 8 cases of severe group (pulmonary hypertension equal to or higher than 80 mm Hg). The types of CHD, cardiac functional status (New York heart association, NYHA), gestational weeks of pregnancy termination, mode of delivery, pregnancy after CHD operation and outcomes of infants were compared between the groups.

Results: (1) The highest incidence of CHD were atrial septal defect and ventricular septal defect (58%, 26/45). The rate of pregnant women after CHD operation was 29% (13/45), they were mainly in slight group and their NYHA class were in I - II. (2) The occurrence rate of NYHA class III - IV was 7 /8 in severe group. The rate of NYHA class I - II was 6/8 in moderate group. The rate of NYHA class I - II was 97% (28/29) in slight group. (3) The rate of term delivery was 93% (27/29), preterm labor 3% (1/29), abortion 3% (1/29), and the birth weight was (3153 +/- 399) g on average in slight group. The rate of term delivery was 5/8, preterm labor occurred in 3 cases in moderate group. The rate of term delivery was 5/8, preterm labor occurred in 2 cases, and iatrogenic abortion in 1 case in severe group. The average birth weight between slight group and moderate or severe group had a significant difference. (4) Caesarean section rate was 78% (35/45) among all patients. The rate of cesarean section delivery was 76% (22/29) in slight group, 6/8 in moderate group, and 7/8 in severe group. (5) The rate of pregnant women who had portent heart failure or heart failure was 24% (11/45), overall maternal mortality was 4% (2/45).

Conclusions: The higher the pulmonary hypertension, the worse the outcome of the mother and fetus; The pregnant women with good heart function after cardiac operation would have a good perinatal outcome. Cesarean section is more suitable for those women.