文章来源:未知 文章作者:enread 发布时间:2011-08-30 03:03 字体: [ ]  进入论坛

Pre-existing heart disease is rarely a contraindication(禁忌症) to pregnancy1 -- indeed, many women with heart disorders2 tolerate pregnancy well -- but it remains3 a "major concern" that complications are frequent and in some cases may be life-threatening for both the mother and her child. In Europe maternal4 heart disease has now become the major cause of maternal death during pregnancy. New ESC Guidelines on the management of cardiovascular disease in pregnancy are published in the European Heart Journal. Their publication, say the authors, comes at a time when the risk of cardiovascular disease in pregnancy continues to rise in developed countries, mainly because of today's older age at first pregnancy and with it a concomitant(相伴的) increase in risks of diabetes5, hypertension and obesity6. In addition, the treatment of congenital heart disease has improved, resulting in a greater number of women with heart disease reaching childbearing age. Nevertheless, congenital heart disease(先天性心脏病) remains the most frequent cardiovascular disease in pregnancy (75-83%), with hypertensive disorders the most frequent cardiovascular events.

It is because of their increasing prevalence and potential severity that the Guidelines describe careful screening for heart disease, appropriate risk assessment7 and counseling as "crucial." Their importance, of course, take on added value when considered in the context of fetal as well as maternal health.

The Guidelines make clear that much of the screening, risk assessment and counseling can be effectively performed in primary care, but, once a cardiovascular disease is suspected or even confirmed, its management is best undertaken by interdisciplinary(各学科间的) teams. High risk patients are recommended for treatment in specialised centres. Thus, diagnostic procedures and interventions9 should be performed by specialists with expertise10 in the techniques and experience in treating pregnant patients.

The general recommendations of the Guidelines are supported by eight sections on specific disease groups: congenital heart disease, aortic11(大动脉的) disease, valvular heart disease, coronary artery12 disease, cardiomyopathies(心肌症) , arrhythmias(心律失常) , hypertensive disorders and venous thromboembolism. A separate section is devoted13 to cardiovascular drugs during pregnancy. Management recommendations include follow-up during pregnancy, medical therapy and intervention8 where appropriate, as well as recommendations for delivery and postpartum care(产后护理) .

However, the Guidelines also note that evidence from prospective14 or randomised studies in this field are sparse15, with recommendations mostly corresponding to evidence level C. Thus, with so many recommendations largely based on retrospective data and broad expert consensus16, the authors concede that registries and prospective studies are urgently needed to improve the state of knowledge.

It is this lack of evidence, they say, which still leaves some issues inconclusively resolved. Thus, while there is agreement that severe pulmonary(肺动脉) hypertension, for example, is a contraindication for pregnancy, there is no clear guidance when that risk becomes acceptable in the presence of less severe pulmonary hypertension. Unfortunately, say the authors, conclusive17 data with this regard are still lacking and make precise recommendations impossible. Anticoagulation therapy during pregnancy in patients with artificial valves or other indications (for anticoagulation) is another controversial area in which prospective studies are urgently needed.

Nevertheless, despite such lack of solid evidence, the authors conclude: "We are convinced that this guideline document is an important contribution and will be considered very helpful for the management of cardiovascular disease during pregnancy in clinical practice."

The Guidelines will be formally introduced at a special session of the 2011 ESC Congress in Paris on 30th August.


1 pregnancy lPwxP     
  • Early pregnancy is often accompanied by nausea.怀孕早期常有恶心的现象。
  • Smoking during pregnancy increases the risk of miscarriage.怀孕期吸烟会增加流产的危险。
2 disorders 6e49dcafe3638183c823d3aa5b12b010     
n.混乱( disorder的名词复数 );凌乱;骚乱;(身心、机能)失调
  • Reports of anorexia and other eating disorders are on the increase. 据报告,厌食症和其他饮食方面的功能紊乱发生率正在不断增长。 来自《简明英汉词典》
  • The announcement led to violent civil disorders. 这项宣布引起剧烈的骚乱。 来自《简明英汉词典》
3 remains 1kMzTy     
  • He ate the remains of food hungrily.他狼吞虎咽地吃剩余的食物。
  • The remains of the meal were fed to the dog.残羹剩饭喂狗了。
4 maternal 57Azi     
  • He is my maternal uncle.他是我舅舅。
  • The sight of the hopeless little boy aroused her maternal instincts.那个绝望的小男孩的模样唤起了她的母性。
5 diabetes uPnzu     
  • In case of diabetes, physicians advise against the use of sugar.对于糖尿病患者,医生告诫他们不要吃糖。
  • Diabetes is caused by a fault in the insulin production of the body.糖尿病是由体內胰岛素分泌失调引起的。
6 obesity Dv1ya     
  • One effect of overeating may be obesity.吃得过多能导致肥胖。
  • Sugar and fat can more easily lead to obesity than some other foods.糖和脂肪比其他食物更容易导致肥胖。
7 assessment vO7yu     
  • This is a very perceptive assessment of the situation.这是一个对该情况的极富洞察力的评价。
  • What is your assessment of the situation?你对时局的看法如何?
8 intervention e5sxZ     
  • The government's intervention in this dispute will not help.政府对这场争论的干预不会起作用。
  • Many people felt he would be hostile to the idea of foreign intervention.许多人觉得他会反对外来干预。
9 interventions b4e9b73905db5b0213891229ce84fdd3     
n.介入,干涉,干预( intervention的名词复数 )
  • Economic analysis of government interventions deserves detailed discussion. 政府对经济的干预应该给予充分的论述。 来自辞典例句
  • The judge's frequent interventions made a mockery of justice. 法官的屡屡干预是对正义的践踏。 来自互联网
10 expertise fmTx0     
  • We were amazed at his expertise on the ski slopes.他斜坡滑雪的技能使我们赞叹不已。
  • You really have the technical expertise in a new breakthrough.让你真正在专业技术上有一个全新的突破。
11 aortic fcbc5d891f31e6a1f809ff1bd4303ba2     
  • The arterial pulse pressure in aortic insufficiency is widened. 主动脉瓣闭锁不全时脉搏压变宽。 来自辞典例句
  • Valvular heart disease, usually aortic and mitral insufficiency, can complicate a variety of systemic diseases. 瓣膜性心脏病,以主动脉瓣及二尖瓣闭锁不全为最常见,可使各种全身性疾病变得复杂。 来自辞典例句
12 artery 5ekyE     
  • We couldn't feel the changes in the blood pressure within the artery.我们无法感觉到动脉血管内血压的变化。
  • The aorta is the largest artery in the body.主动脉是人体中的最大动脉。
13 devoted xu9zka     
  • He devoted his life to the educational cause of the motherland.他为祖国的教育事业贡献了一生。
  • We devoted a lengthy and full discussion to this topic.我们对这个题目进行了长时间的充分讨论。
14 prospective oR7xB     
  • The story should act as a warning to other prospective buyers.这篇报道应该对其他潜在的购买者起到警示作用。
  • They have all these great activities for prospective freshmen.这会举办各种各样的活动来招待未来的新人。
15 sparse SFjzG     
  • The teacher's house is in the suburb where the houses are sparse.老师的家在郊区,那里稀稀拉拉有几处房子。
  • The sparse vegetation will only feed a small population of animals.稀疏的植物只够喂养少量的动物。
16 consensus epMzA     
  • Can we reach a consensus on this issue?我们能在这个问题上取得一致意见吗?
  • What is the consensus of opinion at the afternoon meeting?下午会议上一致的意见是什么?
17 conclusive TYjyw     
  • They produced some fairly conclusive evidence.他们提供了一些相当确凿的证据。
  • Franklin did not believe that the French tests were conclusive.富兰克林不相信这个法国人的实验是结论性的。
TAG标签: heart disease pregnancy