We performed a retrospective cohort analysis of pregnancies among women with moderate to complex congenital heart disease or pulmonary hypertension over a 12-year period, resulting in a cohort of 107 cases in 65 women. Neuraxial analgesia or anaesthesia was provided in 84%, 89% and 95% of spontaneous vaginal, operative vaginal and caesarean deliveries, respectively. The caesarean delivery rate was 43% compared to our institution average of 27% over the same period (p = 0.02), and 38% had operative vaginal deliveries compared to a 10.5% institution rate (p < 0.01). Invasive monitoring was used in 28% of all deliveries. There were one maternal and two neonatal deaths. This study provides detailed anaesthetic and peripartum management of women with congenital heart disease, a patient population in whom evidence-based practice and data are largely lacking. We observed a predominance of neuraxial anaesthetic techniques, increased caesarean and operative delivery rates, and favourable maternal and neonatal outcomes. Multicentre studies and registries to compare anaesthetic and obstetric management strategies further and delineate risk factors for adverse outcomes are required.

译文

:我们对12年来中度至复杂性先天性心脏病或肺动脉高压妇女的妊娠进行了回顾性队列研究,得出65例妇女的107例队列。自发性阴道,手术阴道和剖腹产分别有84%,89%和95%提供神经镇痛或麻醉作用。剖腹产率为43%,而同期我们机构的平均水平为27%(p = 0.02),而手术阴道分娩的比例为38%,而机构率为10.5%(p <0.01)。在所有分娩中有28%使用了侵入式监测。有1例孕产妇死亡和2例新生儿死亡。这项研究为患有先天性心脏病的妇女提供了详细的麻醉和围产期治疗方法,该病患者中大量缺乏循证医学实践和数据。我们观察到神经麻醉技术占优势,剖腹产和手术分娩率增加,孕产妇和新生儿预后良好。需要进行多中心研究和登记,以进一步比较麻醉和产科管理策略,并描述不良后果的危险因素。

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