Multidisciplinary and Stratified Management for Pregnancy Complicated with Heart Diseases

doi:10.12114/j.issn.1007-9572.2018.00.381

Abstract

Abstract: The incidence of cardiovascular diseases during pregnancy in women with heart disease，including previous and newly diagnosed ones is from 0.5% to 3.0%，and it is one of the important causes of maternal mortality.Pregnancy complicated with heart diseases has always been the primary non-obstetric factor of maternal mortality，which highlights the importance of improving the diagnosis，treatment and management of pregnancy complicating heart disease in reducing maternal mortality and improving both maternal and infant outcomes.Because of its complex etiology，hemodynamic changes，coagulation mechanism changes，and pregnancy complications，the diagnosis and treatment of pregnancy complicated with heart disease involves gynecology，obstetrics，cardiology，cardiac surgery，anesthesiology and critical care medicine.Therefore，effective communication and cooperation among different disciplines is the key to the diagnosis and treatment of pregnant women with heart disease.In addition，not every pregnant woman complicated with heart disease has extremely high-risk pregnancy.Therefore，stratified management is the most basic management concept.Community-level health care services and most institutions with the department of maternal and child healthcare should identify，diagnose and assess risks before and during early pregnancy.

Key words: Pregnancy complications, Heart diseases, Disease management

摘要： 妊娠合并心脏病是指妊娠妇女既往有心脏病史或妊娠期间新发心脏病，其发病率为0.5%~3.0%，是造成孕产妇死亡的重要原因之一。妊娠合并心脏病一直居于孕产妇死亡原因非产科因素的首位，因此提高妊娠合并心脏病的诊治及管理水平在降低孕产妇病死率、改善母婴结局方面具有重要作用。由于妊娠合并心脏病病因非常复杂，并伴随妊娠导致的血流动力学改变、凝血机制变化、妊娠并发症等会加重原有疾病，妊娠合并心脏病的诊治涉及妇产科、心内科、心外科、麻醉、重症等诸多临床学科的专业领域，各学科之间如何沟通、有效合作是妊娠合并心脏病孕产妇诊治的关键。此外，并非所有心脏病患者的妊娠属于极高危妊娠，分层管理的概念是这类患者最基本的管理理念，基层、社区保健及大多数有妇幼保健单元的机构应在孕前、孕早期进行识别、诊断和风险评估。

关键词: 妊娠并发症, 心脏病, 疾病管理

ZHANG Jun. Multidisciplinary and Stratified Management for Pregnancy Complicated with Heart Diseases　[J]. Chinese General Practice, 2019, 22(3): 247-252. DOI: 10.12114/j.issn.1007-9572.2018.00.381.
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.

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