Pregnancy outcomes of 103 women with pulmonary arterial hypertension / 中华妇产科杂志

ABSTRACT

Objective To evaluate the pregnancy outcome of women with pulmonary arterial hypertension (PAH).Methods The medical records of 103 pregnant women with PAH admitted to Beijing Anzhen Hospital from January 2007 to March 2011 were studied retrospectively.Results (1) Degree of PAH and cardiac function.Among the 103 PAH,92 cases were patients with congenital heart disease and 13 cases were with rheumatic heart disease.They were divided by color doppler ultrasound into mild PAH group (34 cases),moderate PAH group (22 cases) and severe PAH group (47 cases).Per heart function classification,21 cases (20.4％,21/103) were class Ⅰ,44 cases (42.7％,44/103) were class Ⅱ,27 cases (26.2％,27/103) were class Ⅲ and 11 cases (10.7％,11/103) were class Ⅳ.More patients were class Ⅲ and Ⅳcardiac function in the severe PAH group than in the mild and moderate PAH groups,with statistically significant difference (P ＜ 0.05).(2) Delivery mode.There were 44 term delivery and 23 preterm birth in the 103 PAH patients.Sixty-three cases (94％,63/67) received cesarean section and 4 cases had vaginal delivery.There were 36 iatrogenic abortion (35.0％,36/103).The iatrogenic abortion rate in the severe PAH group was significantly higher than those in the mild and moderate PAH groups (P ＜ 0.05).(3) Perinatal outcomes.The full-term delivery rates in the mild and moderate PAH groups [80％ (20/25) and 14/17] were significantly higher than the severe PAH group (40％,10/25),respectively (P ＜ 0.05).And the premature birth rate of the severe PAH group(60％,15/25) was significantly higher than the mild and moderate PAH group [20％ (5/25)and 3/17,P ＜ 0.05].There were 4 neonatal asphyxia.The birth weight of mild,moderate and severe PAH groups were (3071 ± 443),(2910 ± 619) and (2381 ±589) g,respectively.The birth weight in the severe PAH group was significantly lower than the mild and moderate PAH groups (P ＜ 0.05).(4) Mortality.Nine cases naternal death happened,with a mortality of 8.7％ (9/103).All of them were severe pulmonary hypertension patients.Conclusions PAH is a serious complication during pregnancy.Women with mild PAH and normal cardiac function could continue pregnancy to full-term.Women with moderate PAH might continue pregnancy to 32 weeks under intensive care,cesarean delivery is preferable.Pregnant women with severe PAH should terminate pregnancy because of the high mortality.