The most dangerous pregnancy

May 5th is the”World pulmonary hypertension day”, and the hypertension of the pulmonary arteries is one of the most dangerous pregnancy. Many times doctors are helpless … If "blue lips" patients are pregnant, or "blue lips" occur during pregnancy, this should be "blue lips".How to do it?Recommended reading my article.

In May 2012, a scientific seminar on pulmonary hypertension was held in Madrid, Spain. After 22 patient tissue, 10 rare diseases and its subordinate institutions, and 8 scientific research institutions, they proposed that May 5th of each year was "the worldPulmonary hypertension day ".

"Blue lips" is a sign of pulmonary hypertension, because patients with pulmonary hypertension are purple and blue due to hypoxia.

Pulmonary hypertension is different from hypertension. Hypertension refers to the elevation of aortic pressure, and pulmonary hypertension refers to a set of diseases that cause pulmonary vascular obstruction and increased pulmonary arteries.In the state, the average pulmonary pressure of the right cardiac tube is ≥25 mmHg.

The incidence of hypertension with pulmonary arteries is 1.1/100,000 (11th in the United Kingdom), of which 2/3 of the patients have had pulmonary hypertension in the past.One -third of patients had no pulmonary hypertension before pregnancy. During pregnancy, they were found to have a manifestation of pulmonary hypertension or pulmonary arterial hypertension.The mortality rate of patients with hypertension of pulmonary hypertension is as high as 30-50%. All deaths occur within 35 days before or postpartum. It is the most dangerous situation of pregnancy with heart disease.Taboo!

We have rescued many patients with heart failure and pregnancy -induced arrhythmia in pregnancy. The rescue success rate is very high. However, for the hypertension of pregnancy with pulmonary arteries, we often have no way to do it. Most of the pregnant women who have experienced are patients with pulmonary hypertension.

The clinical clinical of pulmonary hypertension can be divided into five categories:

1. special pulmonary hypertension;

2. Secondary hypertension of the pulmonary artery in the left heart;

3. Inserture in lung disease and/or hypoxemia;

4. Chronic thrombosis embolism and other pulmonary hypertension caused by pulmonary arteries;

5. Pulmonary hypertension caused by other unknown causes and multiple factor mechanisms.

What if the pregnancy is merged with pulmonary arterial hypertension?

Let’s take a look at the specific example:

The case of a case 1:18, the congenital heart ward interval defect, due to various factors, caused the pulmonary artery pressure to rise sharply due to various factors, and there was a significant left to the left to the left. The Eisenmeng syndrome, lost the opportunity of surgery, and died of hypoxia.

Case 2: Systemic lupus erythematosus combined with severe pulmonary artery high pressure. The systemic lupus erythematosus of the pregnant woman has been under the control of the rheumatologist.Because of the asthma and edema performance of pulmonary hypertension, it can also appear among normal pregnant women, and it is easy to be ignored.When the patient arrives at our hospital for delivery, there are obvious pulmonary hypertension, and a sudden heartbeat breathing arrest is stopped when giving birth, and the rescue fails.

Case 3: Obvious pulmonary hypertension occurs at about 4 months of pregnancy, chest tightness and asthma, bilateral edema of lower limbs, and heart ultrasound of the heart of the pulmonary arteries of the heart. The pressure of the pulmonary arteries was 90mmHg. At first, it was suspected that it was congenital heart disease.Various abnormal drainage scans through Pulphic CT vascular imaging and pulmonary vitality and blood flow. Diagnosis is diagnosed as pulmonary arterioscopy, which is diagnosed with pulmonary hypertension caused by pulmonary embolism.After anticoagulanting, the patient’s pulmonary arteries pressure decreased significantly, and the symptoms of chest tightness and asthma and edema were significantly relieved.Finally ending pregnancy, keeping the life of pregnant women.

Case 4: Pregnant women with dilated cardiomyopathy, in the palace in the palace of 7 months of pregnancy, the left ventricular ejection score is less than 30%, the pulmonary arteries pressure is about 50mmHg, severe heart failure, pulmonary hypertension, cannot lie flat, the situation is very criticalThe general diuretic effect is not good. After using the drugs that reduce the pressure of pulmonary arteries while strengthening the heart, the patient’s symptoms are significantly relieved and the induction of labor is successful.

Why do patients with hypertension of pulmonary arterial arterial arterials be so miserable?

This is related to changes in blood flow dynamics after pregnancy. The most significant changes in cardiovascular during pregnancy are the increased blood capacity, and the blood capacity of 20-32 weeks of normal pregnancy can exceed 50%of the non-pregnancy period.Increased heart rate and increased heart rate, increased heart displacement, and decreased body vascular resistance and pulmonary vascular resistance. The number of heart discharge during childbirth has further increased.The heart index increased by 47%.The dangerous period is 48 hours from the 5th to August to the birth of pregnancy.Normal pregnancy is high due to changes in physiology, hormone and blood composition.

Therefore, when patients with pulmonary arterial hypertension go to the hospital for prenatal consultation, doctors will recommend contraception for life and prohibit pregnancy.

If the patient has no pulmonary hypertension before pregnancy, the pulmonary hypertension occurs during pregnancy, what should I do?

1. First of all, identify the symptoms:

Difficulty breathing after labor is the earliest symptoms, but pregnant women with normal pregnancy will also have similar symptoms, which is easy to confuse.At first, the decline, fatigue, and weakness of exercise tolerance were slightly mild, but with the progress of pregnancy, lower limb edema, thoracic ascites, etc. will occur. In severe cases, blood pressure will be reduced. At the same timeIschemia related.

2. Necessary inspection:

(1) ECG

ECG can be manifested as: pulmonary P waves, right bias for electric shafts, thick right ventricular hypertrophy and pressure load, right beam support block and QTC extension.

(2) Heart ultrasound

Cardius ultrasound estimates the average diaphragm contraction, the right ventricular size and function of the desert, and at the same time, you can find some reasons that can indicate pulmonary hypertension such as the contraction and diastolic function of the left ventricle.

(3) Right -hearted catheter

The right cardiac duct measurement of the pulmonary arteries ≥25mmHg is the gold standard for diagnosis of pulmonary hypertension. At the same time, it can calculate pulmonary vascular resistance and right heart output volume. At the same time, the pulmonary vascular dilatation test can be used to reference the use of pulmonary arterial pressure drugs.

3. Treatment:

Once you find that pregnancy is combined with pulmonary hypertension, you must go to hospitals with a comprehensive diagnosis and treatment capacity of pulmonary arteries as soon as possible and the hospital for dangerous production.Medical and such as anesthesiology, neonatal department, etc., according to the symptoms of pregnant women, the causes of pulmonary hypertension, the month of pregnancy, the condition of the fetus, the pressure of the pulmonary artery, and the comprehensive factors of the right heart function to decide whether to continue pregnancy or the emergency termination of pregnancy.

(1) General treatment: Control the intake of liquid and salt. Those with hypoxemia can inhale oxygen. If the right heart function decreases and the liquid retention can be used, diuretics can be used.

(2) Drug therapy and reduce the drug of pulmonary arterial pressure. If the pulmonary vascular dilatation test is positive, you can use calcium ion antagonists, other drugs such as Qianqu Niel, and continuous vein or subcutaneous injection can reduce pulmonary arterial pressure. Pregnant women can use it.But the price is expensive, and the general dose is about 10,000 yuan a month.Endotropolin receptor antagonist, such as Bonastan, has fetal toxicity and taboos in pregnancy.Westsa (Viagra) can be used in pregnancy.

(3) Anesthesia and childbirth methods

The best way to take childbirth is through vaginal delivery, which has the least impact on blood flow dynamics, but most of the pulmonary hypertension pregnant women need an emergency cesarean section to terminate pregnancy.Local anesthesia, such as spinal cord anesthesia, is first considered, and systemic anesthesia due to tracheal intubation will increase the pressure of pulmonary arteries and the exhalation of the ventilator.Avoid use.

As a doctor, we have experienced various pregnancy tragedies, which is the pain we do not want to remember.It is hoped that female friends with high pressure of pulmonary arteries will cherish their lives, live contraception for life, and prohibit pregnancy.If you find that the pulmonary hypertension is discovered after pregnancy, you must go to a regular hospital with a comprehensive diagnosis and treatment ability of pulmonary arterial high pressure and a regular hospital.

Disclaimer: This article is originally created by Dr. Liu Yanrong. Please indicate the author and source for reprinting.

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