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分娩过程是对心脏病孕妇的重大威胁,其血流动学变化甚大,每次宫缩时,右心房压力增加15％,心排出量增加20％,平均动脉压增高10％,导致左心室工作量增加。第二产程中,除子宫收缩外,腹肌及骨骼肌均参加工作,增加了周围阻力。此外产妇用力屏气,使肺循环压力及腹压增高,内脏血液涌向心脏,右心压力骤增,无紫绀型的先天性心脏病会转变为右向左分流的紫绀型,导致缺氧。再加上分娩时宫缩的痛觉,恐惧心理,产程长,疲劳等不利因素,使心排出量累积增加40％。因而合并心脏病的孕产妇在第二产程时,比在第一产程更易发生心衰或甚至死亡。以往的处理产程原则是尽量从阴道分娩,合并心脏病是列为剖宫产禁忌证之一的。随着外科及麻醉科的发展,通过对上述分娩期血液动力学改变的深入认识,在分娩方式的选择上有了较大的改变,剖宫产的指征放宽了,而且不再是合并心脏病的禁忌证了。由于绝大多数心脏病孕妇均为心功能Ⅰ～Ⅱ级
The delivery process is a significant threat to heart disease pregnant women, the hemodynamic changes are very large, each contractions, the right atrial pressure increased by 15%, cardiac output increased by 20%, mean arterial pressure increased by 10%, leading to left ventricular workload increase. The second stage of labor, in addition to contraction of the uterus, abdominal muscles and skeletal muscles to participate in the work, an increase of resistance around. In addition, the maternal forced breath-hold, so that pulmonary pressure and abdominal pressure increased, visceral blood flow to the heart, right heart surge pressure, without cyanotic congenital heart disease will be converted to right-to-left shunt cyanosis, leading to hypoxia. Coupled with labor contractions during childbirth pain, fear, long process, fatigue and other unfavorable factors, so that the cumulative increase in cardiac output by 40%. Thus, pregnant women with heart disease are more likely to have heart failure or even death at the second stage of labor than at the first stage of labor. In the past the principle of the treatment of labor is to try to vaginal delivery, combined with heart disease is listed as one of the contraindications to cesarean section. With the development of surgery and anesthesiology, through the above-mentioned understanding of the hemodynamic changes during labor, there has been a great change in the choice of mode of delivery. The indications for cesarean section have been relaxed and are no longer combined with heart Contraindication of the disease. Because the vast majority of heart disease pregnant women are cardiac function Ⅰ ~ Ⅱ level