Pregnancy in women with heart disease in sub-Saharan Africa
Pregnancy in women with heart disease in sub-Saharan Africa
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DOI：
10.1016/j.acvd.2011.04.001
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发表时间：
2011-06-01
影响因子：
3
通讯作者：
Ba, Serigne Abdou
中科院分区：
文献类型：
--
作者：
Diao, Maboury;Kane, Adama;Ba, Serigne Abdou
背景。 - 尽管之前的研究表明，患有心脏病的妊娠与严重的并发症相关，但很少有研究关注撒哈拉以南非洲地区患有瓣膜性心脏病的患者。方法。 - 我们报告了 8 年期间入住达喀尔大学心脏病学系的 50 名患有心脏病的孕妇的孕产妇和胎儿结局。结果。 - 46 名女性患有风湿性心脏病，其中 7 名曾接受过手术。其余 39 例中，32 例患有二尖瓣狭窄（孤立的或与其他瓣膜病变相关）。入院时，36 名女性出现肺水肿，2 名出现肺栓塞，18 名出现心律失常。共有 17 名孕产妇死亡（34%）。孕产妇死亡与以下因素相关： 二尖瓣狭窄 (P = 0.03)；严重三尖瓣关闭不全（P = 0.001）；纽约心脏协会功能分级 III 或 IV (P=0.001)；心力衰竭症状（P < 0.001）。良好的产妇结局与以下因素相关： 既往心脏事件（P < 0.001）；既往接受过手术瓣膜置换术（P = 0.03）；心脏人工瓣膜（P = 0.03）。共有 30 例活产，6 例胎儿死亡，5 例治疗性流产；九名女性失访。 30 例中，19 例是阴道分娩，11 例是剖腹产。分娩时的中位孕龄为 28 周（范围：8-38 周）。有五名婴儿早产。死产 4 例（新生儿死亡率 7.6%）。结论。 - 在我们的研究中，心脏病严重影响母体和胎儿的结局。怀孕前接受适当瓣膜置换术的孕妇预后较好。 (C) 2011 Elsevier Masson SAS。版权所有。
Background. - Although previous studies showed that pregnancy with heart disease is associated with significant complications, few focused on patients with valvular heart disease in sub-Saharan Africa.Methods. - We report maternal and foetal outcomes in 50 pregnant women with heart disease admitted to the Department of Cardiology of the University of Dakar, during an 8-year period.Results. - Rheumatic heart disease was observed in 46 women, seven of whom had previously been operated on. Among the remaining 39, 32 had mitral stenosis (isolated or associated with other valvular lesions). At admission, 36 women presented with pulmonary oedema, two with pulmonary embolism and 18 with arrhythmia. There were 17 maternal deaths (34%). Maternal death was associated with: mitral stenosis (P = 0.03); severe tricuspid regurgitation (P = 0.001); New York Heart Association functional class III or IV (P=0.001); symptoms of heart failure (P < 0.001). A favourable maternal outcome was associated with: prior cardiac events (P < 0.001); prior surgical valve replacement (P = 0.03); cardiac prosthetic valve (P = 0.03). There were 30 live births, six foetal deaths and five therapeutic abortions; nine women were lost to follow-up. Delivery was vaginal in 19 out of 30 cases and by caesarean section in 11 cases. Median gestational age at delivery was 28 weeks (range, 8-38 weeks). Five births occurred preterm. There were four stillbirths (neonatal mortality, 7.6%).Conclusions. - Heart disease severely impacts maternal and foetal outcome in our study. Pregnant women who underwent appropriate valve replacement before pregnancy had a better prognosis. (C) 2011 Elsevier Masson SAS. All rights reserved.