The Maternal and Fetal Outcomes of Pregnancy Complicated with Congenital Heart Disease with Pulmonary Artery Hypertension

Objective:The maternal and fetal outcomes of pregnancy complicated with congenital heart disease(CHD)with pulmonary artery hypertension were investigated.Methods:A retrospective review of 21 pregnant patients complicated with CHD with pulmonary artery hypertension was done from December 2005 to September 2009.The patients were divided into three groups according to the degree of pulmonary artery hypertension:mild group(from 35 to 54 mmHg)4 cases,moderate group(from 55 to 74 mmHg)6 cases and severe group(≥75 mmHg)11 cases.The types of CHD,cardiac function status,gestational weeks when terminating pregnancy,modes of delivery,the maternal and fetal outcomes were compared among different groups.Results:①The most common types of CHD were atrial septal defect(ASD,38.1%,8/21)and ventricular septal defect(VSD,38.1%,8/21)respectively.The other types were 2 cases of atrioventricular septal defect(AVSD,9.5%,2/21),2 cases of patent ductus arteriosus(9.5%,2/21),1 case of complete pulmonary vein dislocation drainage.ASD comprised main type of mild to moderate group patients(70.0%,7/10),while VSD was the main disease of severe group(72.7%,8/11).②The cardiac function in mild and in moderate group were mainly classⅠ~Ⅱ,only one case in mild group and two cases in moderate group were class Ⅲ.However,no heart failure happened in mild or moderate group,and the outcomes of mother and baby were good.In severe group,patients with class Ⅲ~Ⅳ cardiac function accounted 90.9%(10/11),and 3 cases had early onset or real heart failure before or after delivery,sadly one patient died.③Caesarean section rate was 95.2%(20/21).Term delivery in mild and moderate group were 100%,while in severe group,3 cases were term delivery,6 cases were preterm delivery.④There was 1 case of mild neonatal asphyxia complicating with small for gestational age in moderate group.There were 3 cases of small for gestational age,6 cases of preterm infants and 2 cases of fetal death in severe group.Conclusions:If the pulmonary artery hypertension is higher,the outcomes of mother and fetus are worse.Caesarean section is a safer method to terminate the pregnancy.