Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2019, Vol. 15 ›› Issue (05): 504 -511. doi: 10.3877/cma.j.issn.1673-5250.2019.05.005

Special Issue:

Original Article

High-risk factors of cardiac contractility reserve in the third trimester of high-risk pregnancy and the significance of phonocardiogram test in evaluation of pregnant women′s cardiac contractility reserve

Xiaoqing Wei1, Xiao Yang1,()   

  1. 1. Department of Obstetrics, Chengdu Women′s and Children′s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
  • Received:2019-03-01 Revised:2019-09-19 Published:2019-10-01
  • Corresponding author: Xiao Yang
  • About author:
    Corresponding author: Yang Xiao, Email:
  • Supported by:
    National Natural Science Foundation of China(30770551); National Natural Science Foundation of China for Youth(81202217); Project of Chengdu Women′s and Children′s Central Hospital in 2017(1729)
Objective

To investigate the high-risk factors that may affect the cardiac contractility reserve (CCR) of high-risk pregnant women in the third trimester, and to evaluate the value of the phonocardiogram test (PCGT) in assessment of CCR of pregnant women in the third trimester.

Methods

From May 1, 2013 to July 31, 2013, a total of 65 cases of high-risk pregnant women with CCR abnormalities in the third trimester (28-41+ 6 weeks of gestation) in Chengdu Women′s and Children′s Central Hospital were selected as research subjects and included in study group. Simultaneously, others 489 cases of normal CCR pregnant women in the third trimester (28-41+ 6 gestational weeks) during the same period and in the same hospital were selected as control and included in control group. PCGT were used to measure CCR-related indicators, including heart rate, ratio of the amplitude of the first heart sound to the second heart sound (S1/S2), ratio of diastolic to systolic duration (D/S), and ratio of S1 amplitude at tricuspid valve auscultation area to that at mitral auscultation area (T1/M1). Through questionnaires and medical history taking, 14 factors that might affect CCR-related indicators between two groups of pregnant women were collected, and multivariate unconditional logistic regression analysis was performed to analyze the high-risk factors that might affect the CCR of pregnant women in the third trimester. The consistency of CCR indexes S1/S2, D/S and echocardiographic detection of cardiac ejection fraction (EF) and electrocardiogram results in diagnosis of cardiac function in pregnant women in the third trimester were analyzed. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013. All participants confirmed and signed consent forms for clinical trials.

Results

①Combined with high-risk pregnancies, combined with family history of cardiovascular and cerebrovascular diseases, ≥29-35 years old, ≥35 years old, systolic blood pressure ≥140-160 mmHg (1 mmHg=0.133 kPa) and systolic blood pressure ≥160 mmHg were independent risk factors for abnormal heart rate (OR=3.158, 1.816, 1.760, 1.901, 6.066, 17.055, 95%CI: 1.555-6.415, 1.156-2.853, 1.046-2.960, 1.132-3.194, 1.131-32.548, 2.353-123.599, P=0.001, 0.010, 0.033, 0.015, 0.035, 0.005). Junior college and above education levels of pregnant women was an independent protective factor for heart rate (OR=0.529, 95%CI: 0.321-0.870, P=0.012). ②With 32-34+ 6 gestational weeks, combined with high-risk pregnancy, and systolic blood pressure ≥140-160 mmHg, systolic blood pressure≥160 mmHg were independent risk factors for abnormal S1/S2 (OR=2.400, 5.842, 4.293, 12.875, 95%CI: 1.265-4.553, 2.966-11.506, 1.460-26.467, 2.496-113.852, P=0.007, 0.028, 0.035, 0.005). ③Combined with high-risk pregnancy, diastolic blood pressure ≥90-110 mmHg and diastolic blood pressure ≥110 mmHg were independent risk factors for abnormal D/S (OR=4.706, 1.993, 6.458, 95%CI: 2.556-8.665, 1.532-17.708, 2.391-28.166, P=0.020, 0.010, 0.047). ④Gravidity≥4 times was an independent risk factor for abnormal T1/M1 (OR=9.555, 95%CI: 1.147-77.955, P=0.037). ⑤Among 65 cases of abnormal CCR pregnant women in the third trimester(study group), the coincidence rates of S1/S2 with cardiac EF and routine electrocardiogram results in diagnosis of cardiac function in pregnant women in the third trimester were 93.8% (61/65) and 89.2% (58/65), respectively. And the coincidence rates of D/S with these two examination results were the same as S1/S2.

Conclusions

Multiple pregnancies, 32-34+ 6 gestational weeks, combined with high-risk pregnancies, combined with family history of cardiovascular and cerebrovascular diseases, ≥29 years old, systolic blood pressure ≥140 mmHg, and diastolic blood pressure ≥90 mmHg are risk factors for abnormal CCR in pregnant women in the third trimester. We should strengthen the prenatal care for these pregnant women. The consistency rates of CCR indexes with echocardiography(EF) and routine electrocardiogram results are high, and PCGT has the advantages of easy to operation and low cost in assessment of CCR in pregnant women in the third trimester, and can be used to screen the CCR of these pregnant women.

表1 晚孕期孕妇CCR异常可能影响因素的多因素非条件logistic回归分析的变量含义及其赋值
自变量/因变量 变量名 赋值
心率 y1 y1=0表示心率<100次/min,y1=1表示心率≥100次/min
S1/S2 y2 y2=0表示S1/S2<3.8,y2=1表示S1/S2≥3.8
D/S y3 y3=0表示D/S<1,y3=1表示D/S≥1
T1/M1 y4 y4=0表示T1/M1<3,y4=1表示T1/M1≥3
年龄 x1 x1=0表示年龄<25岁,x1=1表示年龄≥25~29岁,x1=2表示年龄≥29~35岁,x1=3表示年龄≥35岁
职业 x2 x2=0表示未就业,x2=1表示从事体力劳动,x2=2表示从事脑力劳动,x2=3表示从事体力和脑力劳动
文化程度 x3 x3=0表示文化程度为高中及以下,x3=1表示大专及以上
居住地 x4 x4=0表示居住地为农村,x4=1表示居住地为城市
孕次 x5 x5=0表示孕次为1次,x5=1表示孕次为2次,x5=2表示孕次为3次,x5=3表示孕次为≥4次
产次 x6 x6=0表示产次为0,x6=1表示产次为1次,x6=2表示产次为2次,x6=3表示产次≥3次
孕龄 x7 x7=0表示孕龄为28~31+6孕周,x7=1表示孕龄为32~34+6孕周,x7=2表示孕龄为35~41+6孕周
是否合并高危妊娠 x8 x8=0表示未合并高危妊娠,x8=1表示合并高危妊娠
异常孕产史 x9 x9=0表示无异常孕产史,x9=1表示有异常孕产史
心、脑血管疾病家族史 x10 x10=0表示未合并心、脑血管疾病家族史,x10=1表示合并心、脑血管疾病家族史
孕前BMI x11 x11=0表示孕前BMI≥18.5~25.0 kg/m2x11=1表示孕前BMI≥25.0~30.0 kg/m2x11=2表示孕前BMI≥30 kg/m2
孕期体重增加值 x12 x12=0表示孕期体重增加值为≤11.5 kg,x12=1表示孕期体重增加值为≥11.5~16.0 kg,x12=2表示孕期体重增加值为≥16.0 kg
收缩压 x13 x13=0表示收缩压<130 mmHg,x13=1表示收缩压≥130~140 mmHg,x13=2表示收缩压≥140~160 mmHg,x13=3表示收缩压≥160 mmHg
舒张压 x14 x14=0表示舒张压<90 mmHg,x14=1表示收缩压≥90~110 mmHg,x14=2表示收缩压≥110 mmHg
表2 晚孕期孕妇心力储备指标心率异常的可能影响因素的分析结果
表3 晚孕期孕妇心力储备指标S1/S2异常的可能影响因素的分析结果
表4 晚孕期孕妇心力储备指标D/S异常的可能影响因素的分析结果
表5 晚孕期孕妇心力储备指标T1/M1异常的可能影响因素的分析结果
表6 研究组(n=65)孕妇的心力储备指标S1/S2、D/S与超声心动图检测的心脏EF,对于诊断孕妇心脏功能的比较(例)
表7 研究组(n=65)孕妇的心力储备指标S1/S2、D/S与常规心电图检查结果,对于诊断孕妇心脏功能的比较(例)
[1]
Davies GA, Herbert WN. Cardiac disease in pregnancy[J]. Anaesth Intens Care Med, 2016, 17(8): 390-394.
[2]
谢幸,孔北华,段涛. 妇产科学[M]. 9版. 北京:人民卫生出版社,2018: 83-91.
[3]
Arafeh JM, Baird SM. Cardiac disease in pregnancy[J]. Crit Care Nurs Q, 2006, 29(1): 32-52.
[4]
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy[J]. Eur Heart J, 2018, 39(34): 3165-3241.
[5]
于国玲. 妊娠合并心脏病的诊治分析[J]. 世界最新医学信息文摘,2018, 18(8): 151-152.
[6]
苏云霞,于莉莉,侯兆红. 2015—2017年某院二孩分娩数据对比[J]. 中国病案,2018, 19(8): 52-55.
[7]
赵丽云,徐铭军. 妊娠合并心脏病围麻醉期中国专家临床管理共识[J]. 临床麻醉学杂志,2019, 35(7): 703-708.
[8]
关怀,尚丽新. 妊娠合并心脏病的诊断和治疗[J]. 人民军医,2015, 58(8): 963-966.
[9]
杨霄,罗丹,刘德顺,等. 孕晚期孕妇心音图检测心力储备的价值研究[J]. 实用妇产科杂志,2017, 33(5): 376-380.
[10]
Mubarak QU, Akram MU, Shaukat A, et al. Analysis of PCG signals using quality assessment and homomorphic filters for localization and classification of heart sounds[J]. Comput Method Program Biomed, 2018, 164(1): 143-157.
[11]
Bozkurt B, Germanakis I, Stylianou Y. A study of time-frequency features for CNN-based automatic heart sound classification for pathology detection[J]. Comput Biol Med, 2018, 100(1): 132-143.
[12]
杜德奇,有风芝. 孕妇心脏储备功能影响因素分析[J]. 郑州大学学报(医学版), 2010, 45(2): 319-320.
[13]
Xiao S, Guo X, Sun X, et al. A relative value method for measuring and evaluating cardiac reserve[J]. Biomed Eng Online, 2002, 1(1): 6.
[14]
刘国传,肖守中,靳平,等. 心音图运动试验的精密度和准确度的分析[J]. 生物医学工程学杂志,2000, 17(3): 305-308.
[15]
刘天虎,刘剑雄,肖守中,等. 心力储备指数和射血分数量化心功能分级的相关性研究[J]. 四川医学,2005, 26(11): 1197-1198.
[16]
肖守中. 心音-心力关系和心脏储备研究[M]. 北京:国际炎黄文化出版社,2006: 6.
[17]
Xiao SZ, Cao ZH, Zhou SY. An application of phonocardiogram exercise test in evaluation of cardiac reserve[R]. Beijing: In IEEE EM BS′98 Satellite Conference Proceedings, 1998: 82-83.
[1] Jingyu Qian, Mingming Zheng. Interpretation of the Italian guidelines on non-invasive and invasive prenatal diagnosis:executive summary of recommendations for practice the Italian Society for Obstetrics and Gynecology(SIGO)[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 486-492.
[2] Xialin Li, Fang He. Risk assessment and early warning system for postpartum hemorrhage[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 498-503.
[3] Ziyang Liu, Jianjian Cui, Yin Zhao. Current research status on obstetric disseminated intravascular coagulation and its scoring system[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 511-518.
[4] Fanying Zeng, Jie Ruan, Xinghui Liu, Guolin He. Current status of perinatal medicine advances under the new reproductive situation and coping strategies in prenatal care[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 519-524.
[5] Xiaofei Li, Hongli Liu, Qiuling Shi, Jing Tian, Li Li, Hongbo Qi, Xin Luo. A prospective randomized controlled study of low intensity focused ultrasound uterine involution treatment for prevention and treatment of postpartum hemorrhage in natural childbirth women[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 534-539.
[6] Rong Huang, Ziyu Liang, Wenjin Qi. Expression and significance of NLRP3 inflammasome in serum of pregnant women with premature rupture of membranes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 540-548.
[7] Xia He, Rong Huang, Wenjin Qi. High-throughput sequencing study on the abundance of placenta and fetal membrane flora in pregnant women with premature rupture of membranes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 549-555.
[8] Jiangyan Xie, Yafei Wang, Fang He. Pregnancy complicated with thrombotic thrombocytopenic purpura:two cases report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 556-563.
[9] Tingting Xu, Yongchi Zhan, Xiaodong Wang, Xiaodong Wang. Perinatal outcomes of fetomaternal hemorrhage syndrome pregnant women with sinusoidal fetal heart tracing[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 382-389.
[10] Xiaoyan Han, Hua Yang. Relationship between low level of serum placental growth factor in the second trimester pregnancy women and adverse fetal prognosis[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 398-402.
[11] Jiali Du, Rui Bao, Chunhong Qiao, Wei Han. Construction of a prediction model for adverse pregnancy outcomes after emergency cervical cerclage in pregnant women with cervical incompetence during the second trimester[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 403-409.
[12] Juan Tan, Jianxin Tan, Binbin Shao, Yan Wang, Zhengfeng Xu. Current research status on non-invasive prenatal testing for fetal with single gene inheritance diseases[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(03): 245-250.
[13] Xue Lin, Meng Chen, Meilin Yang, Xinghui Liu, Hongyu Zhou. Perinatal outcomes of pregnant women with myasthenia gravis and risk factors for disease exacerbation of myasthenia gravis[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(02): 125-132.
[14] Saijun Jia, Ying Zhang, Jiayi Wan. Pregnancy outcomes in pregnant women with subclinical hypothyroidism[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(02): 140-147.
[15] Xiaorong Peng, Wei Mo, Qin Li, Yaqin Wu, Lan Li. Knowledge, attitude and practice of venous thromboembolism prevention and influencing factors among pregnant women[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2024, 12(03): 274-280.
Viewed
Full text


Abstract