Supervisor: National Health Commission of the PRC
Sponsored by: Chinese Medical Doctor Association
China Medical University
Sponsored by: Chinese Medical Doctor Association
China Medical University
Hypertensive heart disease in pregnancy is a serious complication of hypertensive disorder in pregnancy involving the heart and causing cardiac dysfunction.The disease often manifests as left heart failure and pulmonary edema，which is one of the important causes of maternal non-obstetric death.The key to its treatment lies in early identification and comprehensive management of multidisciplinary collaboration，including blood pressure control，rational drug use，volume management，delivery decision，perinatal safety，and many other aspects.
Peripartum cardiomyopathy（PPCM）is an unexplained decline in cardiac contractile function during late pregnancy and at several months after delivery，characterized by left ventricular dysfunction and heart failure.PPCM has not received significant attention from clinical practitioners due to its relative rarity，but its incidence rate has increased year by year in recent years, and it has become one of the leading causes of maternal mortality worldwide.The symptoms of peripartum heart failure often resemble the physiological changes associated with pregnancy，which usually makes early diagnosis difficult and leads to related complications.This article focuses on the diagnosis and therapeutic management of peripartum cardiomyopathy to enhance clinical physicians' understanding of this condition.
Pregnancy complicated by rheumatic heart disease（RHD）represents a complex and high-risk obstetric condition that significantly impacts both maternal and fetal outcomes.This article provides a comprehensive review of the management strategies for RHD during pregnancy based on the latest epidemiological data，pathophysiological mechanisms，diagnostic criteria，and therapeutic approaches, highlighting the importance of multidisciplinary collaboration，pre-pregnancy evaluation，and personalized intervention，thereby offering evidence-based evidence for clinical practice.
Pulmonary arterial hypertension（PAH）poses significant maternal and fetal risks during pregnancy，including heart failure，PAH crisis，maternal death，fetal growth restriction，fetal distress，and preterm birth.In recent years，individualized management has gradually replaced the traditional strategy of absolute contraindication to pregnancy.This review summarizes risk assessment methods and management strategies for PAH in pregnancy，including preconception counseling，pregnancy monitoring，pharmacological and delivery management，and postpartum follow-up.Future efforts should focus on optimizing risk assessment systems of PAH and advance intelligent management in order to improve maternal and neonatal survival.
Arrhythmias are common cardiac conditions during pregnancy，and severe arrhythmias may endanger maternal and fetal health，leading to serious consequences.Therefore, it is essential to conduct risk assessments in high-risk women before pregnancy and provide close prenatal care during pregnancy.In terms of treatment，the drugs or other therapies with minimal impact on the mother and fetus should be the best options.The choice of delivery method should be made based on both cardiac function and obstetric considerations，with the recommendation of using anesthetic agents.After delivery，continuous monitoring of the mother's cardiac function is necessary，and treatment should be adjusted promptly while ensuring the safety of breastfeeding.It is hoped that multidisciplinary and individualized interventions will improve the pregnancy outcomes of patients with arrhythmias during pregnancy.
Maternal cardiac arrest is a rare complication in obstetrics. Although it has a low incidence rate，it is an important reason for seriously threatening the life safety of pregnant women and fetuses.The causes of maternal cardiac arrest include obstetric and nonobstetric factors.Resuscitation of maternal cardiac arrest is challenging and requires consideration of a range of pregnancy-related factors，including physiological changes of pregnant women during pregnancy，high-quality cardiopulmonary resuscitation，and the need for perimortem cesarean section.Resuscitation of pregnant patients presents unique challenges，and is the guideline for the standards that CPR and resuscitation strategies should follow, with a little modification.Multidisciplinary cooperation is essential to improving the success rate of rescue.This article reviews the key points of management and knowledge update of maternal cardiac arrest.
Venous thromboembolism（VTE）has become one of the leading causes of maternal mortality in China.With the increase in advanced pregnancy，obesity，and pregnancy complications，the incidence of VTE shows a trend of significant increase.Clinical manifestations of VTE are diverse but non-specific，with DVT typically presenting as unilateral lower limb edema and pain，while PE may present with dyspnea and chest pain.The diagnosis requires multiple auxiliary examinations including CUS and CTPA，with careful differentiation from conditions such as amniotic fluid embolism.The treatment primarily involves anticoagulation with low molecular weight heparin，while in severe PE cases thrombolytic therapy may be considered.High-risk populations should receive physical prophylaxis and necessary pharmacological prevention from early pregnancy.Early recognition and timely and standardized multidisciplinary treatment are crucial for improving maternal and fetal outcomes.
Autoimmune diseases during pregnancy（such as systemic lupus erythematosus and antiphospholipid syndrome）are significant causes of fetal arrhythmia.Maternal anti-SSA/Ro and anti-SSB/La antibodies cross the placenta and attack the fetal cardiac conduction system，mediating myocardial injury and congenital heart block（CHB）.Meanwhile, inflammatory factors and placental dysfunction further exacerbate fetal cardiac electrophysiological dysregulation.The clinical manifestations are primarily characterized by atrioventricular block（AVB），which may lead to heart failure or even intrauterine fetal demise in severe cases.Antenatal management requires a multidisciplinary approach，utilizing echocardiography to dynamically monitor fetal cardiac structure and electrophysiological activity and make early identification of incomplete AVB and myocardial injury markers.Hydroxychloroquine administration before and during pregnancy can reduce CHB risk，while glucocorticoid therapy may have potential interventional value for certain early lesions，though maternal-fetal safety must be rigorously evaluated.The evidence for intervention measures such as intravenous immunoglobulin and sympathomimetic agents remains limited，necessitating individualized risk-benefit assessment.This review systematically summarizes the pathological mechanisms，monitoring strategies，and intervention principles for fetal arrhythmia in pregnancy with autoimmune diseases，emphasizing the importance of integrated management across preconception，antepartum，and postpartum periods.Future research should focus on developing immune regulatory targets and precision diagnostic-therapeutic techniques to improve maternal-fetal outcomes.
Cardiovascular disease is one of the important causes of maternal mortality.More than 25% of maternal deaths caused by heart disease can be prevented.Irrational drug use during the perinatal period and volume overload during fluid therapy increase the risk of heart disease in pregnant women，which are important causes of maternal mortality.This article briefly summarizes the drugs commonly used in pregnant women that may cause cardiac dysfunction and pregnancy-associated complications which are the causes of heart failure and pulmonary edema due to abnormal volume.The aim is to discuss how to reduce the incidence of perinatal heart disease in pregnant women through rational drug therapy and individualized fluid treatment strategies.
Pregnancy with heart disease is a serious complication that threatens the health of both the mother and the fetus.During pregnancy，the risk of acute cardiovascular events such as heart failure increases due to hemodynamic changes.Early diagnosis is an important prerequisite to avoid acute cardiovascular events，and accurate auxiliary examination strategies are the key to achieving early diagnosis.There are many examination options for pregnancy with heart disease.A reasonable and personalized examination strategy should be developed based on the specific condition of the disease and the application characteristics of the examinations in order to enhance the effectiveness of the examinations and ensure the safety of both the mother and the fetus.
Objective To assess the value of the serum luteinizing hormone（LH）level on the human chorionic gonadotropin（hCG）administration day for predicting the live birth rate（LBR）after in vitro fertilization-embryo transfer（IVF-ET）treatment. Methods This was a retrospective cohort study.A total of 378 female patients were included, who underwent IVF-ET treatment with the gonadotropin-releasing hormone（GnRH）antagonist protocol and had their first fresh cycle embryo transfer at Tianjin Medical University General Hospital from June 2017 to April 2024. All patients received ovulation induction treatment with the GnRH antagonist protocol and were divided into a low-LH group（LH ≤ 1.67U/L）and a high-LH group（LH>1.67U/L）according to the serum LH level on the hCG administration day.Evaluate the effects of such factors as the LH level on the hCG administration day，body mass index（BMI），and ovarian reserve function on the pregnancy outcome. Results There were no significant differences in the biochemical pregnancy rate，clinical pregnancy rate，or live birth rate between the low-LH group and high-LH group（P>0.05）.However，the regression analysis showed that female age，the number of transferred embryos，and the thickness of the endometrium were significantly correlated with the live birth rate（P<0.05）.The predictive role of the LH level on the hCG administration day in the pregnancy outcome did not show independence，while age and endometrial thickness might be stronger predictors for the live birth rate. Conclusions The LH level on the hCG administration day, as an independent predictor, does not play a significant role in the prediction of the live birth rate after treatment，indicating that it might not be a decisive factor affecting the pregnancy outcome.Nevertheless，such factors as age and endometrial thickness play an important role in predicting the live birth rate，suggesting that the success rate of IVF-ET treatment should be evaluated individually by combining multiple physiological indicators.
Objective To explore the occurrence and high-risk factors affecting prognosis of micro-metastasis （occult metastatic lesions） in stage I ovarian clear cell carcinoma patients during comprehensive staging surgery or restaging surgery. Methods A retrospective analysis was performed on 160 patients with ovarian clear cell carcinoma admitted to Peking Union Medical College Hospital from February 2015 to December 2019，including 91 patients with lesions confined to the ovary at the time of surgery. Patients' age，surgical procedure，intraoperative findings，restaging surgery procedure, FIGO stage，pathological results and follow-up information were recorded in detail. Patients were divided into two groups based on the initial treatment approach：the comprehensive staging surgery group，who underwent comprehensive staging surgery at the initial treatment，and the restaging surgery group，who either did not undergo staging surgery or underwent incomplete staging at the initial treatment and subsequently underwent restaging surgery. Kaplan-Meier was used to plot survival curve and calculate and compare patients' overall survival and progression-free survival. COX risk regression model was used for prognostic analysis. Results The 91 patients was considered as clinical stage I with a median age of 49 years （22-71 years） and a mean tumor size of （10.6±4.6） cm at the time of initial surgical exploration. The level of preoperative CA125 increased in 35 patients （38.5%）. Totally 51 cases （56.0%） underwent comprehensive staging in the primary surgery，and 40 cases （44.0%） underwent restaging surgery. The confirmed metastasis rate after comprehensive staging surgery and restaging surgery was 15.4% (14/91).FIGO stage was upgraded in 14 patients(15.4%)，including 6 patients （6.6%） was upgraded to stage Ⅱ and 8 patients （8.8%） to stage Ⅲ. After operation，85 patients （93.4%） received platinum-based chemotherapy，and 6 patients （6.6%） did not receive chemotherapy. The mean follow-up time was （49.5±19.5） months，the recurrence rate was 19.8%, and the mortality rate was 8.8%. FIGO stage was upgraded to Ⅱ-Ⅲ in 17.6% （9/51） of the patients in the comprehensive staging group and 12.5% （5/40） in restaging group. The lymph node metastasis rate of the two groups was 7.8% （4/51） and 7.5% （3/40），respectively，the difference being with no statistical significance （P>0.05）. The 5-year progression-free survival rate of patients in the comprehensive staging group and the restaging group was 74.2% and 92.0%，respectively （P=0.063）. The 5-year overall survival rate of the two groups was 86.0% and 90.7%，respectively （P=0.676）. Univariate analysis showed that FIGO stage （Ⅲ compared toⅠ, Ⅱ） had a statistically significant effect on progression-free survival （HR=4.158，95%CI 1.334-12.963，P=0.014），while restaging surgery, compared to comprehensive staging surgery, had no statistical effect on progression-free survival （HR=0.361，95%CI 0.117-1.109，P=0.075） and overall survival （HR=1.349，95%CI 0.337-5.401，P=0.672）. Multivariate analysis showed that FIGO stage Ⅲ had a statistically significant effect on PFS compared with stage I and II （HR=5.570，95%CI 1.196-25.940，P=0.029）. Conclusions The rates of upgrading of stage and lymph node metastasis of stage Ⅰovarian clear cell carcinoma are not low, and the upgrading of tumor stage is still an independent risk factor affecting prognosis. Therefore，the diagnosis rate of suspected early clear cell carcinoma of ovary should be increased in the initial operation，and the rate of incomplete surgical staging and restaging should be reduced.
Objective To compare the mid-term and long-term clinical efficacy of transvaginal dot-matrix CO2 laser with that of AI temperature-controlled radiofrequency in the treatment of stress urinary incontinence. Methods Complete data of 100 patients who received treatment for stress urinary incontinence in outpatient department from January 2020 to May 2022 were retrospectively analyzed.Among them, 46 patients received dot-matrix CO2 laser therapy（laser group）and 54 patients received AI temperature-controlled RF therapy（RF group）.At 6 and 12 months after the end of treatment the clinical efficacy（1-hour urine pad）and the Urinary Incontinence Questionnaire（ICI-Q-SF）score of the International Urinary Incontinence Committee were compared between the two groups. Results At 6 months，the effective rate of laser group and RF group was 91.3%（42/46）and 72.2%（39/54）.The total effective rate in laser group was higher than that in RF group（P<0.05），especially in patients with mild urinary incontinence（96.4% vs. 60.0%）or age > 40 years old（88.5% vs. 60.0%）.The ICI-Q-SF score of the two groups was lower than before treatment，and the score of the laser group was lower than that of the RF group[（5.21±3.07）vs. (6.59 ± 3.64）, P<0.05].At 12 months，the effective rate in laser group was lower than that at 6 months（91.3% vs. 65.2%, P<0.05），but there was no significant difference in RF group（72.2% vs. 68.5%, P>0.05）. There was no significant difference in effective rate or ICI-Q-SF score between the two groups. Conclusion Both transvaginal dot-matrix CO2 laser and AI temperature-controlled radiofrequency therapy are effective in the treatment of stress urinary incontinence，and the effect of laser therapy is better than that of radiofrequency after 6 months，especially for patients with mild urinary incontinence or age > 40 years，but the effect of them are similar after 12 months.
