Objective To evaluate the clinical characteristic and pregnancy outcome of in women with repaired tetralogy of Fallot during the second and third trimester.Methods Totally 80 pregnancy women with repaired tetralogy of Fallot (observation group) and 80 pregnancy women without heart disease (control group) from January 2007 to May 2015 were retrospectively analyzed.The age,gestational weeks,delivery mode,proportion of premature infant and low birth weight infant,birth weight were compared between groups.Depending on whether the patients were complicated with residual shunt and tricuspid regurgitation,the pregnancy women were stratificated,and the heart function and pregnancy outcomes (full term and preterm delivery,premature birth,low birth weight infant,birth weight) were analyzed.Results Among 38 cases,cardiovascular events occurred in 3 cases,2 cases were complicated with severe preeclampsia,1 case had fetal growth restriction,4 cases were complicated with gestational diabetes or impaired glucose tolerance.Totally 32 cases(84.2％) got full term delivery,6 cases (15.8％) got preterm delivery (1 case ＜ 28 gestational weeks).The age,gestational weeks and birth weight of their babies in observation group were significantly less/lower than those in control group [(27 ± 5) years vs (30±4) years,(37.3 ±2.6) weeks vs (39.1 ±1.2) weeks,3 075 (2 753,3 413) g vs 3 350 (3 150,3 590) g],the cesarean section rate,incidences of preterm delivery,premature birth and low birth weight in observation group were significantly higher than those in control group [86.8％ (33/38) vs 52.5％ (42/80),10.5％ (4/38) vs 1.3％ (1/80),11.1％ (4/38) vs 1.3％ (1/80),11.1％ (4/38) vs 0.0％ (0/80)] (P＜0.05).The cardiac function was significantly poorer,the birth weight was significantly lower,the stillbirth rate was significantly higher in patients with residual shunt than those in patients without residual shunt [heart function Ⅲ-Ⅳ class 60.0％ (3/5) vs0.0％ (0/33),2 650 (1 590,2 848)g vs 3 135 (2 873,3 518) g,20.0％ (1/5) vs 3.0％ (1/33)] (P ＜ 0.05),while the full term delivery rate and incidence of low birth weight were not significantly different (P ＞ 0.05).The cardiac function was significantly poorer,the full term delivery rate and birth weight were significantly lower in patients with severe tricuspid regurgitation than those in patients without tricuspid regurgitation and patients with slight or moderate tricuspid regurgitation [heart function class Ⅲ-Ⅳ:50.0％ (2/4) vs 0.0％ (0/3),3.2％ (1/31);25.0(1/4) vs 100.0％ (3/3),90.3(28/31);(1 270,2 385,2 640)g vs (2 650,3 000,3 300) g,3 135 (2 878,3 545) g] (P ＜ 0.05),while the incidence of low birth weight was not significantly different (P =0.05).Conclusions Women with repaired tetralogy of Fallot can tolerate the hemodynamic change during the second and third trimester and can get good perinatal outcome,but the perinatal outcome is not as good as women without heart disease.Residual shunt and severe tricuspid regurgitation are probably important adverse factors of pregnancy outcome,which should be paid attention in pregnancy management.%目的 探讨法洛四联症术后中晚期妊娠患者的临床特点及其妊娠结局状况.方法 回顾性分析首都医科大学附属北京安贞医院2007年1月年至2015年5月38例法洛四联症术后中晚期妊娠患者(观察组)的临床资料,以同期非心脏病妊娠80例作为对照组,比较观察组和对照组的年龄、孕周、分娩方式、早产、早产儿、低出生体质量儿、新生儿出生体质量.根据患者是否合并残余分流、三尖瓣反流,将观察组孕妇分别分层,分析其心功能和妊娠结局指标(足月分娩、早产、低出生体质量儿、新生儿出生体质量)的差异.结果 38例患者中,3例发生心血管事件,2例合并重度子痫前期,1例胎儿生长受限,4例合并妊娠期糖尿病或糖耐量受损.38例患者中足月产32例(84.2％),未足月产6例(15.8％,其中未足28周1例).观察组孕妇年龄、孕周、新生儿出生体质量小于对照组,剖宫产率、早产发生率、早产儿发生率、低出生体质量儿发生率高于对照组,差异有统计学意义[(27±5)岁比(30±4)岁、(37.3±2.6)周比(39.1±1.2)周、3 075(2 753,3 413)g比3 350(3 150,3 590)g、86.8％ (33/38)比52.5％ (42/80)、10.5％ (4/38)比1.3％(1/80)、11.1％ (4/38)比1.3％ (1/80)、11.1％(4/38)比0.0％(0/80),P＜0.05].合并残余分流组较不合并残余分流组的心功能差、新生儿出生体质量轻、死产发生率高,差异有统计学意义[心功能Ⅲ～Ⅳ级60.0％(3/5)比0.0％(0/33)、2 650(1 590,2 848)g比3 135(2 873,3 518)g、20.0％ (1/5)比3.0％(1/33),P＜0.05];足月分娩率、低出生体质量儿发生率差异无统计学意义(P＞0.05).重度三尖瓣反流组较无三尖瓣反流组及轻中度三尖瓣反流组心功能差、足月分娩率低、新生儿出生体质量轻,差异有统计学意义[心功能Ⅲ～Ⅳ级50.0％ (2/4)比0.0％(0/3)、3.2％(1/31),25.0(1/4)比100.0％(3/3)、90.3(28/31),(1 270,2 385,2 640)g比(2 650,3 000,3 300)g、3 135(2 878,3 545)g,P＜0.05],低出生体质量儿发生率差异无统计学意义(P=0.05).结论 法洛四联症术后妇女能较好的耐受妊娠期和分娩期血流动力学变化,取得良好的妊娠结局,但其妊娠结局不如非心脏病孕产妇.残余分流、严重的三尖瓣反流可能是影响法洛四联症术后妇女妊娠结局的重要因素.故对此类患者的妊娠管理,应关注残余分流、三尖瓣反流程度.
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