The number of women with congenital heart disease (CHD) who are of childbearing age is increasing due to advancements in medical management. Nonetheless, data on the outcomes of delivery in women with CHD remain limited. Therefore, we conducted a retrospective cohort study using a nationwide database of deliveries by women with CHD. Deliveries by women with CHD discharged from acute-care hospitals between April 2017 and March 2018 were identified based on the Diagnosis Procedure Combination database which covers almost all acute-care hospitals in Japan. By using this database, we tried to include relatively high-risk deliveries by women with CHD. Subjects were divided into three groups according to the underlying disease complexity: simple, moderate, and great complexity. The clinical characteristics and incidence of peripartum cardiovascular events were compared among the three groups. A total of 249 deliveries from 107 hospitals were included. The largest facility had 29 deliveries per year. Given the uncertainty of underlying cardiac anomalies, 48 women were excluded, and the remaining 201 women (median age, 32 years) were analyzed. In-hospital maternal death, use of extracorporeal membrane oxygenation, intra-aortic balloon pump, pacemaker, and direct current cardioversion were not observed. Nine patients (4.5%) required intravenous diuretic administration. However, the difference in the frequency of diuretic use was not significant among the three groups (simple, 1.9%; moderate, 7.2%; great, 6.9%; P = 0.204). One participant required valve replacement surgery at 22 days after a successful cesarean section. As the disease complexity increased, deliveries occurred more frequently at university hospitals (simple, 41.7%; moderate, 52.2%; great, 72.4%; P = 0.013) and the length of hospitalization was significantly longer, with median durations of 9.0 (interquartile range [IQR] 7.0–11.0) days, 10.0 (IQR 8.0–24.0) days, and 11.0 (IQR 8.0–36.0) days in the simple, moderate, and great complexity groups, respectively (P = 0.002). Appropriate patient selection and management by specialized tertiary institutions may contribute to positive outcomes in pregnancies in women with CHD.

中文翻译：

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在日本急诊医院分娩的先天性心脏病女性的结果：使用日本全国诊断程序组合数据库的回顾性队列研究

由于医疗管理的进步，患有先天性心脏病（CHD）的育龄妇女人数正在增加。尽管如此，关于冠心病女性分娩结果的数据仍然有限。因此，我们使用全国性冠心病妇女分娩数据库进行了一项回顾性队列研究。2017 年 4 月至 2018 年 3 月期间从急诊医院出院的冠心病妇女的分娩是根据涵盖日本几乎所有急诊医院的诊断程序组合数据库确定的。通过使用该数据库，我们尝试将 CHD 女性的相对高风险分娩包括在内。受试者根据潜在疾病的复杂性分为三组：简单、中度和高度复杂。比较三组患者的临床特点及围产期心血管事件发生率。共包括来自 107 家医院的 249 名分娩。最大的工厂每年有 29 次交付。鉴于潜在心脏异常的不确定性，48 名女性被排除在外，其余 201 名女性（中位年龄 32 岁）进行了分析。未观察到院内孕产妇死亡、体外膜肺氧合、主动脉内球囊泵、起搏器和直流电复律的使用。9 名患者 (4.5%) 需要静脉注射利尿剂。然而，三组间利尿剂使用频率的差异不显着（简单，1.9%；中度，7.2%；极好，6.9%；P = 0.204）。一名参与者在成功剖腹产后 22 天需要进行瓣膜置换手术。随着疾病复杂性的增加，在大学医院分娩的频率更高（简单，41.7%；中等，52.2%；很好，72.4%；P = 0.013）并且住院时间显着更长，中位持续时间为 9.0（四分位距[IQR] 7.0–11.0) 天、10.0 (IQR 8.0–24.0) 天和 11.0 (IQR 8.0–36.0) 天，分别为简单、中等和高度复杂组 (P = 0.002)。由专门的三级机构进行适当的患者选择和管理可能有助于 CHD 女性妊娠的积极结果。0 (IQR 8.0–24.0) 天和 11.0 (IQR 8.0–36.0) 天分别在简单、中等和高度复杂组中 (P = 0.002)。由专门的三级机构进行适当的患者选择和管理可能有助于 CHD 女性妊娠的积极结果。0 (IQR 8.0–24.0) 天和 11.0 (IQR 8.0–36.0) 天分别在简单、中等和高度复杂组中 (P = 0.002)。由专门的三级机构进行适当的患者选择和管理可能有助于 CHD 女性妊娠的积极结果。