电邮这篇文章 Pregnancy management and spontaneous labor in heart diseases: present-day solution to the dilemma
- 作者: Mravyan S.R.1, Petrukhin V.A.1, Zarudskiy A.A.2, Pronina V.P.3, Mravyan SR3, Petrukhin VA3, Zaprudsky AA3, Pronina VP3
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隶属关系:
- ГУЗ Московский областной НИИ акушерства и гинекологии
- Белгородская областная клиническая больница Святителя Иосафа
- Московский областной НИИ им. М. Ф. Владимирского
- 期: 卷 81, 编号 10 (2009)
- 页面: 9-15
- 栏目: Editorial
- URL: https://journal-vniispk.ru/0040-3660/article/view/30518
- ID: 30518
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Aim: to study cardiac rhythm variability (CRV), to optimize pregnancy management tactics and to choose a delivery procedure.
Subjects and methods. Ninety-six 19-to-37 year-old (mean age 28.3±9.4 years) women at 35-39 weeks gestational age were examined. All the women were diagnosed as having congenital or acquired (rheumatic) heart disease. Their hemodynamics and CRV were analyzed according to the type of hemodynamic overload, for which purpose three patient groups were formed: 1) volume overload; 2) pressure overload; and 3) combined overload. A control group comprised 40 healthy pregnant women. Before and 2-3 days after delivery, all the women underwent 24-hour Holter cardiac rhythm monitoring with the estimation of the temporary and spectral parameters of CRV.
Results. In antepartum heart diseases accompanied by volume overload, there was a tendency for total CRV (SDNN 95.4 ± 15.8 msec versus 125.5 ± 17.8 msec in the controls) to decrease and for sympathetic activity to significantly increase (SDANN 65.7 ± 13.7 and 109.9 ± 14.7 msec, respectively; p < 0.05). When pressure overload (a moderate gradient) developed, the temporary parameters of total CRV, sympathetic and parasympathetic activities did not differ from those in the control group. Heart diseases attended by pressure overload and a high gradient were characterized by a significant reduction in total CRV (100.5 ± 24.6 msec; p < 0.05) as compared with those in patients having a moderate pressure gradient, with a declining trend for total spectrum power, Group 3 patients showed a reduction in all the indices reflecting the temporary and spectral characteristics, suggesting a considerable rise in sympathetic activity and a decrease in total autonomic spectrum power.
Conclusion. Based on SRV studies, indications for prolonged pregnancy and spontaneous or, in some cases, surgical delivery can be assessed in pregnant women with heart diseases.
Subjects and methods. Ninety-six 19-to-37 year-old (mean age 28.3±9.4 years) women at 35-39 weeks gestational age were examined. All the women were diagnosed as having congenital or acquired (rheumatic) heart disease. Their hemodynamics and CRV were analyzed according to the type of hemodynamic overload, for which purpose three patient groups were formed: 1) volume overload; 2) pressure overload; and 3) combined overload. A control group comprised 40 healthy pregnant women. Before and 2-3 days after delivery, all the women underwent 24-hour Holter cardiac rhythm monitoring with the estimation of the temporary and spectral parameters of CRV.
Results. In antepartum heart diseases accompanied by volume overload, there was a tendency for total CRV (SDNN 95.4 ± 15.8 msec versus 125.5 ± 17.8 msec in the controls) to decrease and for sympathetic activity to significantly increase (SDANN 65.7 ± 13.7 and 109.9 ± 14.7 msec, respectively; p < 0.05). When pressure overload (a moderate gradient) developed, the temporary parameters of total CRV, sympathetic and parasympathetic activities did not differ from those in the control group. Heart diseases attended by pressure overload and a high gradient were characterized by a significant reduction in total CRV (100.5 ± 24.6 msec; p < 0.05) as compared with those in patients having a moderate pressure gradient, with a declining trend for total spectrum power, Group 3 patients showed a reduction in all the indices reflecting the temporary and spectral characteristics, suggesting a considerable rise in sympathetic activity and a decrease in total autonomic spectrum power.
Conclusion. Based on SRV studies, indications for prolonged pregnancy and spontaneous or, in some cases, surgical delivery can be assessed in pregnant women with heart diseases.
作者简介
Sergey Mravyan
ГУЗ Московский областной НИИ акушерства и гинекологии
Email: lakmoniiag@mail.ru
в. н. с; ГУЗ Московский областной НИИ акушерства и гинекологии
Vasiliy Petrukhin
ГУЗ Московский областной НИИ акушерства и гинекологии
Email: lakmoniiag@mail.ru
руководитель 1 акушерской клиники; ГУЗ Московский областной НИИ акушерства и гинекологии
Aleksandr Zarudskiy
Белгородская областная клиническая больница Святителя Иосафа
Email: okb@bel.ru
врач-кардиолог, кардиологическое отд; Белгородская областная клиническая больница Святителя Иосафа
Viktoriya Pronina
Московский областной НИИ им. М. Ф. Владимирского
Email: moniki@mоnikiweb.ru
в. н. с; Московский областной НИИ им. М. Ф. Владимирского
S Mravyan
V Petrukhin
A Zaprudsky
V Pronina
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