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妊娠合并心脏病严重的威胁孕产妇的健康,即使无心功不全,在孕期也易发生心衰,特别在分娩期,甚至危及生命,故分娩期的处理十分重要。现就我院1981～1982年29例妊娠合并心脏病分娩期的处理作如下分析。临床资料我院两年共收治妊娠合并心脏病患者29例,其中心功Ⅰ、Ⅱ级患者21例,Ⅲ级以上者8例。所有这些患者皆在临产前入院,经内科医师会诊评定心脏功能,进一步由产科医生决定分娩方式。 (一)发病率:两年内收容总产妇为7978例,心脏病为29例,发病率为0.36％,在围产期无1例死亡。 (二)产次与年龄:在29例心脏病中,初产妇28例,经产妇只有1例。年龄21～31岁者27例,高龄初产只有2例。 (三)心脏病的分娩方式及分类:自然分娩者1例,单纯侧切分娩者8例,侧切胎头真空吸引术者10例,剖宫产术者10例。29例中先心病9例,风心病6例,心肌炎4例,妊娠高血压综合征心脏病3例,心包炎1例。妊娠合并心脏病的患者中,并存产科异常者(骨盆狭窄、早破、妊高征、滞产、高龄初产、宫内窘迫、双胎等)17例,占56.8％,其中有6例并存二种产科异常情况,其余12例系心脏病正常分娩。在29例中有心衰者8例,其中剖宫产者5例,阴道助产分娩者3例。在内科医生配合下给予心脏监护并积极抢救治疗,分别进行了手术,安全渡过了产期。
Pregnancy complicated by heart disease threatens the health of pregnant women, even without heart failure, also prone to heart failure during pregnancy, especially during childbirth, and even life-threatening, it is very important during childbirth. Now on our hospital from 1981 to 1982, 29 cases of pregnancy complicated with heart disease during delivery for the following analysis. Clinical data in our hospital for two years were treated in 29 cases of pregnancy complicated with heart disease, of which 21 cases of heart function Ⅰ, Ⅱ grade patients, Ⅲ grade more than 8 cases. All of these patients were admitted to hospital before labor, assessed by the physician’s consultation for heart function, and further obstetricians decided on the mode of delivery. (A) Incidence: The total number of maternal and grandchildren was 7978 and 29 respectively in two years, with a morbidity of 0.36%. There was no death during the perinatal period. (B) parity and age: 29 cases of heart disease, primipara 28 cases, only 1 case of mothers. 27 cases were 21 to 31 years old, and only 2 cases were advanced primipara. (C) of the delivery mode and classification of heart disease: 1 case of natural childbirth, simple lateral delivery in 8 cases, lateral head vacuum suction in 10 cases, 10 cases of cesarean section. 29 cases of congenital heart disease in 9 cases, 6 cases of rheumatic heart disease, myocarditis in 4 cases, 3 cases of pregnancy induced hypertension heart disease in 3 cases, 1 case of pericarditis. Among the patients with pregnancy complicated with heart disease, there were 17 cases (56.8%) with obstetric abnormalities (pelvic stricture, premature rupture, pregnancy induced hypertension, delayed labor, early pregnancy loss, intrauterine distress, twins) Two obstetric abnormalities, the remaining 12 cases of normal delivery of heart disease. There are 8 cases of heart failure in 29 cases, of which 5 cases of cesarean section, 3 cases of vaginal delivery. In cooperation with the physician to give cardiac monitoring and active rescue treatment, were performed surgery, safety through the delivery period.