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年的中度至复杂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分析,结果在65名妇女中进行了107例病例的队列研究。分别在84%,89% 和95% 自发阴道,手术阴道和剖腹产时提供了神经镇痛或麻醉。与同期的机构平均27% 相比,剖腹产率43% (p = 0.02),与10.5% 机构相比,38% 进行了阴道分娩 (p <0.01)。侵入性监测用于28% 所有分娩。有1名产妇和2名新生儿死亡。这项研究提供了先天性心脏病妇女的详细麻醉和围产期管理,先天性心脏病是一个缺乏循证实践和数据的患者人群。我们观察到神经麻醉技术占主导地位,剖腹产和手术分娩率提高,孕产妇和新生儿结局良好。需要进行多中心研究和注册,以进一步比较麻醉和产科管理策略,并描述不良结局的风险因素。

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