怀孕后果在女性与关假体:一个系统的审查和元分析
Pepijn Grashuis1, Shanti D M Khargi1, Kevin Veen1
1Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
JTCVS open
|July 10, 2023
概括
对于想要怀孕的女性,在关节置换 (MVR) 后,建议使用生物假体而不是机械. 如果选择机械,建议持续服用低剂量口服抗凝剂以尽量减少风险.
科学领域:
- 心脏病学 心脏病学
- 产科 产科 产科 产科 产科
- 生物医学工程 生物医学工程
背景情况:
- 在生育年龄的妇女中,心交置换 (MVR) 由于怀孕的影响,在假肢选择方面存在困境.
- 生物假体有早期结构损坏的风险,而机械假体需要终身抗凝治疗,伴有孕产妇和胎儿的风险.
- 在MVR后怀孕期间最佳的抗凝策略仍然不确定.
研究的目的:
- 评估与不同假体门和抗凝疗方案相关的风险,在接受MVR的孕妇中.
- 为了为计划未来怀孕的女性在MVR后的临床决策提供信息.
主要方法:
- 对报告MVR后怀孕结果的研究进行系统审查和元分析.
- 在怀孕和产后期间与膜和抗凝相关的孕产妇和胎儿风险的分析.
主要成果:
- 来自15项涉及722个怀孕的研究数据显示,87.2%的孕妇使用机械假肢,12.5%的孕妇使用生物假肢.
- 产妇死亡率为1.33%,出血风险为6.90%,机械栓血栓形成风险为4.71%. 生物假体有3.23%的早期结构膜恶化的风险,死亡率为40%.
- 与生物假体 (13.50%) 相比,机械假体 (29.29%) 的妊娠损失风险更高. 特定的抗凝血疗法影响了出血和血栓形成的风险,剂量≤5mg显示胎儿不良事件较少.
结论:
- 生物假体似乎是孕育年龄妇女考虑MVR后未来怀孕的首选选择.
- 对于那些选择机械的人来说,连续低剂量口服抗凝剂代表了更有利的抗凝疗方案.
- 在为计划怀孕的年轻女性选择假体门时,共享决策至关重要.
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