Аннотация

Цель
To study the features of functional and hemodynamic disorders in the mother-placenta-fetus system in pregnant women with heart defects.
Материал и методы
A prospective examination of 30 pregnant women with heart defects with identified disorders of the uteroplacental-fetal blood flow, who gave birth in a third-level institution - the State Institution «TNII OBGiP» in 2023-2024. The control group consisted of 30 healthy women who gave birth to full-term babies with a body weight corresponding to the gestational age. All pregnant women underwent Doppler ultrasound of the uterine arteries, umbilical artery, and middle cerebral artery of the fetus at gestational ages of 28-31, 32-36, and 37-39 weeks. Pregnant women with heart defects at the first visit (up to 12 weeks of gestation) were given an assessment of the severity of clinical symptoms of heart failure according to the NYHA classification, heart rhythm disturbances were identified by Holter monitoring, and the risk of developing cardiovascular complications was limited according to the GARPREG index
Результаты
In pregnant women with heart defects, pathological changes in electrocardiography were detected in 40% of cases, arrhythmia was noted in 44.4%, functional class III of heart failure was diagnosed in 53.3%, II in 36.7%, I in 6.7% and IV in 3.3%; 46% of pregnant women had an average risk of developing cardiovascular complications, 35% had a severe risk and 19.0% had a low risk. Statistically significant hemodynamic changes were found in all angle-independent indices: systolic-diastolic ratio (SDR), pulsation index (PI) and resistance index (RI) in the umbilical artery, uterine arteries and middle cerebral artery. 38.7% of newborns were born with fetal growth retardation syndrome.
Заключение
Pregnant women with heart defects are characterized by the presence of functional and hemodynamic disturbances in the “mother-placenta fetus” system, which contributes to an increased risk of adverse perinatal outcomes. For this category of patients, it is necessary to develop a system for stratifying the risk of complications for both the mother and the fetus, taking into account not only the severity of the heart defect, but also the obstetric and gynecological history, the presence of concomitant extragenital pathology, prognosis of cardiovascular complications according to the CARPREG scale, results of ultrasound doppler of the fetus

Ключевые слова

pregnancy heart defects heart rhythm Holter monitoring doppler.

Полный текст

Скачать статью в PDF

Полная версия статьи в формате PDF

Список литературы

  1. Balmagambetova G.N., Nugmanova Zh.M., Lisogor S.A. et al. Congenital heart defects are one of the main causes of perinatal and infant mortality // Actual problems of theoretical and clinical medicine. — 2022. — 1 (35). — P. 49-56.
  2. Potapova M.V., Makarova Yu.A., Shamrova E.A., Belova O.A. Cardiovascular diseases in women during pregnancy, features of pathogenesis and clinical course // Scientific review. Medical sciences. — 2021. — 3. — P. 85-89.
  3. Rudaeva E.V. Congenital heart defects and pregnancy // Fundamental and clinical medicine. — 2019. — T. 4(3). — P. 102-112.
  4. Shigabutdinova T.N., Gabidullina R.I., Imangulova L.I. Cardiovascular diseases in pregnant women in the cardiac screening program // Obstetrics and Gynecology: news, opinions, training. — 2025. — T. 13 (1). — P. 66-71.
  5. Vygovskaya L. M., Maidannik I. V. Features of the hemodynamics of the mother-placenta-fetus system in the first half of pregnancy after the use of assisted reproductive technologies // Health of woman. — 2020. — 7 (153). — P. 62-66.
  6. Pestrikova T.Yu., Yurasova E.A., Tkachenko V.A. Placental insufficiency as a basic pathology of complications and outcomes of the gestational period // Russian Bulletin of Obstetrician-Gynecologist. — 2020. — V. 1. — P. 5-15.
  7. Tsibizova V.I., Pervunina T.M. Key function of the placenta in the formation of congenital heart defects of the fetus // Obstetrics, gynecology and reproductive science. — 2022. — Vol. 16(1). — P. 66-72.
  8. Doronina P.Yu. Pregnancy with heart defects // Alley of Science. — 2019. — V. 1(28). — P. 231-239.
  9. Anum S., Minhas M.D., Faisal Rahman et al. Cardiovascular and Obstetric Delivery Complications in Pregnant Women With Valvular Heart Disease // The American Journal of Cardiology. — 2021. — Vol. 158 (1). — P. 90-97.
  10. Hardee I. Maternal and Neonatal Outcomes of Pregnancies in Women With Congenital Heart Disease: A Meta-Analysis // Am Heart Assoc. — 2021. — 10(8). — e017834. doi: 10.1161/JAHA.120.017834.
  11. Meskhi N.T., Lyashko E.S., Konysheva O.В., Lukina N.N., Lapotchkina O.B. Features of the course of pregnancy in women with a pacemaker // Problems of reproduction. — 2024. — 30(6). — P. 124-131.
  12. Bottega N. Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease // Congenit Heart Dis. — 2019. — N14. — Р. 735–744.
  13. Kholturaev A.T. Clinical and hemodynamic assessment of rhythm disturbances in pregnant women according to Holter monitoring data // Economy and Society. — 2021. — P. 1189–1192.
  14. Iris M van Hagen, Jolien W Roos-Hesselink, Ntiloudi D. Pregnancy in patients with congenital heart disease: risk prediction and counselling // Cardiol Rev. — 2017. — Nov/Dec. 25(6). — Р. 326-330.
  15. Seitler S, Ahmad M, Ahuja SAC, Ahmed MT et al. Routine Antenatal Echocardiography in High-Prevalence Areas of Rheumatic Heart Disease: A WHO-Guideline Systematic Review // Glob Heart. — 2024. — 19(1):39. doi: 10.15212/gh.1318.