Outcome of Pulmonary Vascular Disease in Pregnancy: A Systematic Overview From 1978 Through 1996

Синдром Эйзенменгера (СЭ) – это обструктивное заболевание легочных сосудов, развивающееся вследствие длительно существовавшего внутри-сердечного шунта слева – направо, приводящего к гипертрофии мышечного слоя легочных арте-рий и развитию тяжелой легочной гипертензии. Одними из тяжелейших осложнений этого син-дрома являются выравнивание системного и вну-трилегочного артериального давления, и, в итоге, реверсия шунта – справа – налево, вызывающая резкую гипоксемию.Беременность у больных СЭ ассоциируется с крайне высоким риском как для матери, так и для плода. Характерна задержка развития пло-да, а также высокая (28%) перинатальная смерт-ность, обусловленная преждевременными ро-дами. Материнская смертность при подобных заболеваниях составляет около 45%. При этом смерть наступает чаще в первую неделю после ро-дов, реже в течение первого месяца. Материнская смертность после кесарева сечения при этой па-тологии составляет 47%, после самостоятельных родов – 33%, а после искусственного прерывания беременности – 6% [34, 47]. Учитывая это, женщи-нам, страдающим СЭ, беременность категориче-ски противопоказана, и необходимо своевремен-ное ее прерывание.Ниже мы приводим клинические наблюде-ния беременных с СЭ, поступивших в клинику ФГУ «НЦ АГиП им. академика В. И. Кулакова» Минздравсоцразвития РФ в 2010 г. Одна из них была успешно пролечена и родоразрешена, второй пришлось прервать беременность по ме-дицинским показаниям.

http://cyberleninka.ru/article/n/vedenie-beremennosti-i-rodov-u-zhenschin-s-sindromom-eyzenmengera-klinicheskie-nablyudeniya-i-obzor-literatury.pdf

Ведение беременности и родов у женщин с синдромом Эйзенменгера: клинические наблюдения и обзор литературы

Eisenmenger's syndrome in pregnancy: A case report and review

Two cases of spontaneous delivery at 27 weeks and 38 weeks are reported in two patients with Eisenmenger's syndrome. One case did not present any problems, while the other was followed by maternal death on the 6th day post-partum. The cause of death was similar to that of other cases reported in the literature. The pathophysiological explanation of the terminal clinical condition with refractory hypoxia remains unclear. In view of the maternal mortality of about 50 per cent, these patients should be prescribed effective contraception, free of thrombogenic and infectious risks. The therapeutic approach in patients who become pregnant is not well defined. However, a number of principles should be observed during delivery: oxygen therapy, rapid correction of haemorrhages, the timing and the modalities of anti-coagulation are controversial. The failure of the usual methods of resuscitation in the terminal stage raises the possibility of using fibrinolytics.

[Eisenmenger's syndrome and pregnancy. Apropos of 2 spontaneous deliveries, one of which was fatal].

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[Eisenmenger's syndrome and pregnancy. Apropos of 2 spontaneous deliveries, one of which was fatal].