Feasibility study of single-stage cesarean section and cardiac surgery in pregnant women with severe heart disease in the third trimester

doi:10.3877/cma.j.issn.1673-5250.2022.01.006

Objective

To explore feasibility of single-stage cesarean section and cardiac surgery in pregnant women with severe heart disease (SHD) in the third trimester.

Methods

A total of 21 cases of pregnant women with SHD in the third trimester who received single-stage cesarean section and cardiac surgery in Beijing Anzhen Hospital, Capital Medical University from 2012 to 2020 were selected as research subjects. General clinical data, perioperative conditions and pregnancy outcomes of mothers and infants were retrospectively analyzed. The procedure followed in this study complied with requirements of the Medical Ethics Committee of Beijing Anzhen Hospital, Capital Medical University and was approved by the ethics committee (Approval No. 2022027X).

Results

①At delivery, the age of 21 cases of SHD pregnant women was (30.8±4.0) years old, body mass index (BMI) was (25.0±5.6) kg/m². Gestational age of delivery was (32.5±3.5) gestational weeks, including 6 cases (28.6%) of term delivery. 22 newborns were born, and neonatal body length was (45.1±3.9) cm, body weight was (2 342.0±727.3) g. Apgar scores of 1 min, 5 min and 10 min after birth were (7.4±2.5) points, (9.0±1.0) points and (9.6±1.0) points, respectively. Neonatal survival rate was 100.0% (22/22). ②In 21 cases of SHD pregnant women, there were 13 cases (61.9%) of aortic dissection, 7 cases (33.3%) of thoracic/abdominal aortic aneurysm, 6 case (28.6%) of pericardial effusion, and 5 cases (23.8%) of cardiac enlargement. Moderate and severe aortic regurgitation accounted for 61.9% (13/21), and 90.5% (19/21) of patients with cardiac function grade Ⅱ or above. 18 cases (85.7%) had two or more kinds of SHD. ③There were 8 kinds of cardiac operation in single-stage with cesarean section by multi-disciplinary team (MDT). The operation time of cardiac operation was (369.8±100.6) min and volume of blood loss was 1 157.4 mL (750.0-1 550.0 mL). Cardiopulmonary bypass (CPB) time was (139.0±45.1) min and all pregnant women survived.

Conclusions

For SHD pregnant women in the third trimester, it is feasible to perform single-stage cesarean section and cardiac surgery by MDT to provide protection for maternal and neonatal life safety.

Key words: Pregnancy complications, cardiovascular, Heart diseases, Pregnancy trimester, third, Cardiac surgical procedures, Pregnancy outcome, Pregnant women

表1 本组21例晚孕期SHD孕妇的SHD类型、合并症、主动脉瓣关闭不全及心功能分级情况[例数(%)]

项目		发生率	项目		发生率	项目		发生率
SHD类型			合并症			主动脉瓣关闭不全
	主动脉夹层	13(61.9)		妊娠期高血压疾病	7(33.3)		中度	7(33.3)
	胸/腹主动脉瘤	7(33.3)		妊娠期糖尿病	5(23.8)		重度	6(28.6)
	心包积液	6(28.6)		马方综合征	3(14.3)	心功能分级(级)
	心脏扩大	5(23.8)		肺不张	3(14.3)		Ⅰ	2(9.5)
	心律失常	2(9.5)		双胎妊娠	1(4.8)		Ⅱ	6(28.6)
	心房黏液瘤	2(9.5)	主动脉瓣关闭不全				Ⅲ	8(38.1)
	感染性心内膜炎	1(4.8)		无/轻度	8(38.1)		Ⅳ	5(23.8)

表1 本组21例晚孕期SHD孕妇的SHD类型、合并症、主动脉瓣关闭不全及心功能分级情况[例数(%)]

项目		发生率	项目		发生率	项目		发生率
SHD类型			合并症			主动脉瓣关闭不全
	主动脉夹层	13(61.9)		妊娠期高血压疾病	7(33.3)		中度	7(33.3)
	胸/腹主动脉瘤	7(33.3)		妊娠期糖尿病	5(23.8)		重度	6(28.6)
	心包积液	6(28.6)		马方综合征	3(14.3)	心功能分级(级)
	心脏扩大	5(23.8)		肺不张	3(14.3)		Ⅰ	2(9.5)
	心律失常	2(9.5)		双胎妊娠	1(4.8)		Ⅱ	6(28.6)
	心房黏液瘤	2(9.5)	主动脉瓣关闭不全				Ⅲ	8(38.1)
	感染性心内膜炎	1(4.8)		无/轻度	8(38.1)		Ⅳ	5(23.8)

表2 本组21例晚孕期SHD孕妇分娩孕龄及心脏病手术术式比较[例数(%)]

项目		发生率	项目		发生率
分娩孕龄(周)			心脏手术术式
	<37	15(71.4)		Bentall手术+部分主动脉弓人工血管置换术	2(9.5)
	≥37	6(28.6)		Bentall手术+冠状动脉旁路移植术	1(4.8)
心脏手术术式				左心房黏液瘤切除术	2(9.5)
	Bentall手术	6(28.6)		Valsalva手术	1(4.8)
	Bentall+SUN′S手术	4(19.0)		主动脉瓣机械瓣膜置换±二尖瓣瓣环成形+升主动脉包裹术	3(14.3)
	主动脉置换术	2(9.5)

表2 本组21例晚孕期SHD孕妇分娩孕龄及心脏病手术术式比较[例数(%)]

项目		发生率	项目		发生率
分娩孕龄(周)			心脏手术术式
	<37	15(71.4)		Bentall手术+部分主动脉弓人工血管置换术	2(9.5)
	≥37	6(28.6)		Bentall手术+冠状动脉旁路移植术	1(4.8)
心脏手术术式				左心房黏液瘤切除术	2(9.5)
	Bentall手术	6(28.6)		Valsalva手术	1(4.8)
	Bentall+SUN′S手术	4(19.0)		主动脉瓣机械瓣膜置换±二尖瓣瓣环成形+升主动脉包裹术	3(14.3)
	主动脉置换术	2(9.5)

[1]	Zhu JM, Ma WG, Peterss S, et al. Aortic dissection in pregnancy: management strategy and outcomes[J]. Ann Thorac Surg, 2017, 103(4): 1199-1206. DOI: 10.1016/j.athoracsur.2016.08.089.
[2]	伍军平，张金陶，温金兰，等. 2000—2013年度广州市花都区孕产妇死亡原因分析[J/CD]. 中华妇幼临床医学杂志(电子版), 2014, 10(1): 75-78. DOI: 10.3877/cma.j.issn.1673-5250.2014.01.018.
[3]	Ma WG, Zhu JM, Chen Y, et al. Aortic dissection during pregnancy and postpartum in patients with Marfan syndrome: a 21-year clinical experience in 30 patients[J]. Eur J Cardiothorac Surg, 2020, 58(2): 294-301. DOI: 10.1093/ejcts/ezaa048.
[4]	Cauldwell M, Johnson M, Jahangiri M, et al. Cardiac interventions and cardiac surgery and pregnancy[J]. Int J Cardiol, 2019, 276: 43-47. DOI: 10.1016/j.ijcard.2018.09.100.
[5]	王守军. 妊娠合并心脏病360例临床分析[J]. 系统医学， 2020, 5(4): 107-109, 112. DOI: 10.19368/j.cnki.2096-1782.2020.04.107.
[6]	Kapoor MC. Cardiopulmonary bypass in pregnancy[J]. Ann Card Anaesth, 2014, 17(1): 33-39. DOI: 10.4103/0971-9784.124133.
[7]	陆树洋，姚王超，黄奔，等. 妊娠合并急性Stanford A型主动脉夹层：单中心治疗经验及文献回顾[J]. 中华胸心血管外科杂志， 2021, 37(1): 14-17. DOI: 10.3760/cma.j.cn112434-20191019-00366.
[8]	中华医学会妇产科学分会产科学组. 妊娠合并心脏病的诊治专家共识(2016)[J]. 中华妇产科杂志， 2016, 51(6): 401-409. DOI: 10.3760/cma.j.issn.0529-567x.2016.06.001.
[9]	房姝妍，李涛淘，梁婷. 快速康复外科应用于子宫下段剖宫产围术期的效果分析[J]. 中国现代药物应用， 2021, 15(16): 224-226. DOI: 10.14164/j.cnki.cn11-5581/r.2021.16.087.
[10]	沈丹萍. 心外科手术病人的围手术期的护理方法和效果探讨[J]. 保健文汇， 2019, 20(11): 100-101. DOI: 10.14164/j.cnki.cn11-5581/r.2021.16.087.
[11]	Liu Y, Han F, Zhuang J, et al. Cardiac operation under cardiopulmonary bypass during pregnancy[J]. J Cardiothorac Surg, 2020, 15(1): 92. DOI: 10.1186/s13019-020-01136-9.
[12]	侯倩，崔炜. 妊娠合并艾森曼格综合征的管理方案及预后研究进展[J]. 中华围产医学杂志， 2020, 23(12): 859-862. DOI: 10.3760/cma.j.cn113903-20200422-00366.
[13]	Avila WS, Rossi EG, Ramires JA, et al. Pregnancy in patients with heart disease: experience with 1，000 cases[J]. Clin Cardiol, 2003, 26(3): 135-142. DOI: 10.1002/clc.4960260308.
[14]	Diao M, Kane A, Ndiaye MB, et al. Pregnancy in women with heart disease in sub-Saharan Africa[J]. Arch Cardiovasc Dis, 2011, 104(6-7): 370-374. DOI: 10.1016/j.acvd.2011.04.001.
[15]	Patel A, Asopa S, Tang AT, et al. Cardiac surgery during pregnancy[J]. Tex Heart Inst J , 2008 , 35(3): 307-312.
[16]	景赫，卢家凯，卿恩明. 20例妊娠合并艾森曼格综合征剖宫产麻醉管理经验[J]．心肺血管病杂志， 2012, 31(2): 113-116. DOI: 10.3969/j.issn.1007-5062.2012.02.005.
[17]	周晓瑞，张京岚，卢家凯，等. 妊娠合并肺动脉高压149例临床分析[J]. 心肺血管病杂志， 2013, 32(5): 544-548. DOI: 10.3969/j.issn.1007-5062.2013.05.003.
[18]	包照亮，张军. 合并严重心血管疾病孕妇妊娠早中期终止妊娠的方法选择及围术期管理[J]. 中华妇产科杂志， 2018, 53(9): 608-612. DOI: 10.3760/cma.j.issn.0529-567x.2018.09.005.
[19]	Elassy SM, Elmidany AA, Elbawab HY. Urgent cardiac surgery during pregnancy: a continuous challenge[J]. Ann Thorac Surg, 2014, 97(5): 1624-1629. DOI: 10.1016/j.athoracsur.2013.10.067.
[20]	Hessel EA 2nd. What′s new in cardiopulmonary bypass[J]. J Cardiothorac Vasc Anesth, 2019, 33(8): 2296-2326. DOI: 10.1053/j.jvca.2019.01.039.
[21]	Wanga S, Silversides C, Dore A, et al. Pregnancy and thoracic aortic disease: managing the risks[J]. Can J Cardiol, 2016, 32(1): 78-85. DOI: 10.1016/j.cjca.2015.09.003.
[22]	乔志钰，陈苏伟，里程楠，等. 妊娠合并Stanford A型主动脉夹层的外科治疗[J]. 中华血管外科杂志， 2021, 6(1): 5-10. DOI: 10.3760/cma.j.cn101411-20210201-00012.
[23]	Chen SW, Zhong YL, Ge YP, et al. Successful repair of acute type A aortic dissection during pregnancy at 16th gestational week with maternal and fetal survival: a case report and review of the literature[J]. World J Clin Cases, 2019, 7(18): 2843-2850. DOI: 10.12998/wjcc.v7.i18.2843.
[24]	Kostadinovska B, Nikolic A, Slaveski D, et al. Acute aortic dissection in a patient with Marfan syndrome during advanced pregnancy[J]. J Card Surg, 2020, 35(2): 499-502. DOI: 10.1111/jocs.14408.
[25]	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. DOI: 10.1093/eurheartj/ehy340.
[26]	张军. 妊娠合并心脏病的多学科(分层)管理[J]. 中国全科医学， 2019, 22(3): 247-252. DOI: 10.12114/j.issn.1007-9572.2018.00.381.

[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]	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.
[10]	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.
[11]	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.
[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]	Huihui Yu, Zongzhi Yin. Gastric perforation during pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(04): 209-213.
[14]	Shan Lu, Yunshan Yao, Seni Liao, Zien Chen, Yijian Zhang, Jianhao Lan, Wei Wei, Yanyang Liu, Yanhong Chen, Duijin Chen. Clinical study of 100 cases of suspected pregnancy complicated with acute appendicitis[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(04): 214-219.
[15]	Wenyan Wang, Jianlan Zheng, Lici Zhu. Clinical study on the risk of pregnancy and perinatal period after in vitro fertilization and embryo transfe[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(04): 220-226.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export