[Management of heart failure and timing of delivery in pregnancy].

OBJECTIVE: To explore the management of heart failure, the timing of delivery in pregnancy, and the influence on pregnant prognosis. METHODS: We retrospectively analyzed the incidence of heart failure, treatment results, pattern of termination, and time of termination in 356 cases of pregnancy with heart disease. RESULTS: One hundred and thirty-six (38.20%) cases were diagnosed as heart failure and 76 (55.88%) were moderate or severe heart failure. Heart failure tends to occur more easily in rheumatic heart diseases than in congenital heart diseases. Heart failure occurred more frequently in pregnancy with rheumatic heart diseases without the heart operation before pregnancy than that of pregnancy with congenital heart diseases. The occurence of the moderate and severe heart failure in pregnancy decreased in rheumatic heart diseases with surgical therapies compared with those without surgical therapies (P <0.05). Compared with pregnancy with heart failure controlled inadequately, pregnancy with effectively controlled heart failure had better tolerance during delivery and through the pregnancy, and puerperium. CONCLUSION: Congenital heart diseases and rheumatic heart diseases are the chief causes of heart failure during the gestation. Therapy before pregnancy, especially surgery to the rheumatic heart diseases, may improve the cardiac function during pregnancy. Monitoring heart function and selecting the proper timing to terminate pregnancy after controlling the heart failure in late pregnant period will be helpful to improve the prognosis of pregnant and perineonate.