心疾患合併妊婦の母児の予後について

The investigation was carried out on 82 pregnant women with firm diagnoses of cardiac disease, who delivered 84 infants, including two cases of twin pregnancies, during a six and a half year period from January 1971 through June 1977 at the Obstetrical Floor of National Fukuyama Hospital. As a result; (1) In 39 cases (47.6%), diagnosis was rheumatic heart disease, and 30 cases (36.6%) had congenital heart disease. Other 13 cases (15.9%) were associated with miscellaneous heart disease. (2) According to functional classifications of the New York Heart Association, 74 cases (90.2%) was evaluated as either Class I or II, and other 8 cases (9.8%) was either Class III or IV. (3) Five cases (6.1%) developed cardiac insufficiencies; one case at home, one case during hospitalization and repeatedly during cesarean section, and three cases during labors. (4) Two women (2.4%) resulted in fatal outcome. One case with mitral stenosis, who was poorly managed by a general physician and developed pulmonary edema at home, died immediately after emergent admission and delivery of dead fetus at the 29th gestational week. One case with patent ductus arteriosus died 5 months after recovery from cardiac arrest due to a massive hemorrhage from placenta previa during cesarean section. (5) As pregnancy complications, nine cases (11.0%) had premature deliveries, two cases (2.4%) with breech presentations, two cases (2.4%) with twin pregnancies, and two cases (2.4%) developed severe toxemia of pregnancy. (6) Seventy six infants (90.5%) were delivered vaginally; 31 cases (36.9%) by either vacuum extractions or forceps deliveries, and two cases (2.4%) by breech extractions. Cesarean sections were performed on 6 cases (7.3%), however, only one case (1.2%) was for cardiac reason. (7) Perinatal mortality rate was 1.2% due to fore mentioned intrauterine fetal death.(8) As perinatal morbidities, 8 cases (9.5%) was IUGR, 5 cases (6.0%) with SFD, 3 cases (3.6%) with asphyxia neonatorum, 4 cases (4.8%) with respiratory insufficiencies, and one case (1.2%) had congenital heart disease. Modern management of cardiac disease in pregnancy was also discussed.