Severe pulmonary hypertension during pregnancy -: Mode of delivery and anesthetic management of 15 consecutive cases
Severe pulmonary hypertension during pregnancy -: Mode of delivery and anesthetic management of 15 consecutive cases
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DOI：
10.1097/00000542-200506000-00012
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发表时间：
2005-06-01
期刊：
影响因子：
8.8
通讯作者：
Benhamou, D
中科院分区：
文献类型：
--
作者：
Bonnin, M;Mercier, FJ;Benhamou, D
背景：关于严重肺动脉高压（PH）孕妇的现有文献主要依赖于轶事病例报告和两个系列。方法：作者回顾了过去 10 年来在其机构随访的所有严重 PH 孕妇的图表，以评估这些患者的多学科治疗和结果。结果：在此期间管理了 14 名严重 PH 孕妇中的 15 次妊娠：有 4 例患有特发性肺动脉高压（PAH），先天性心脏病相关PAH 6例，芬氟拉明相关PAH 1例，混合结缔组织相关PAH 1例，人类免疫缺陷病毒相关PAH 1例，慢性血栓栓塞性PH 2例。 3 名患者在妊娠期间出现 PH。两名患者在妊娠 12 周和 23 周的分娩前死亡。 4 名患者在区域麻醉下进行阴道分娩：1 名患者在产后 3 个月死亡，1 名病情恶化，2 名病情稳定。 4 名患者在全身麻醉期间进行了剖腹产：1 名患者在产后 3 周死亡，1 名病情恶化，2 名病情稳定。 5 名患者在低剂量腰硬联合麻醉期间进行了剖腹产：1 名患者在产后一周死亡，4 名患者情况稳定。共有两例胎儿死亡：一例与妊娠 21 周时的治疗性流产有关，一例与妊娠 36 周时的死产有关，随后母亲在 1 周后死亡。结论：尽管采取了最现代的治疗措施，孕产妇死亡率仍为 36%。在腰硬联合麻醉期间进行预定的剖腹产似乎是一种有吸引力的方法，但没有证据表明有实际益处。因此，严重PH患者一定要避免怀孕。
Background: Available literature on pregnant women with severe pulmonary hypertension (PH) relies mainly on anecdotal case reports and two series only.Methods: The authors reviewed the charts of all pregnant women with severe PH who were followed up at their institution during the past 10 yr, to assess the multidisciplinary treatment and outcome of these patients.Results: Fifteen pregnancies in 14 women with severe PH were managed during this period: There were 4 cases of idiopathic pulmonary arterial hypertension (PAH), 6 cases of congenital heart disease-associated PAH, 1 case of fenfluramine-associated PAH, 1 case of mixed connective tissue-associated PAH, 1 case of human immunodeficiency virus-associated PAH, and 2 cases of chronic thromboembolic PH. PH presented during pregnancy in 3 patients. Two patients died before delivery at 12 and 23 weeks' gestation. Four patients had vaginal deliveries with regional anesthesia: One died 3 months postpartum, one worsened, and two remained stable. Four had cesarean deliveries during general anesthesia: One died 3 weeks postpartum, one worsened, and two remained stable. Five had cesarean deliveries during low-dose combined spinal-epidural anesthesia: One died I week postpartum, and four remained stable. There were two fetal deaths: one related to therapeutic abortion at 21 weeks' gestation and one stillbirth at 36 weeks' gestation followed by the death of the mother 1 week later.Conclusions: Despite the most modern treatment efforts, the maternal mortality was 36%. Scheduled cesarean delivery during combined spinal-epidural anesthesia seemed to be an attractive approach, but there was no evidence of actual benefit. Therefore, pregnancy must stiff be discouraged in patients with severe PH.