Pregnant! After 10 years of heart transplantation, she finally has children

*For medical professionals only

In order to meet her fertility wishes, the doctor's team developed a 2-year "pregnancy preparation plan" for her.

On the morning of January 26, 2022, 37-year-old Xizi (pseudonym) successfully gave birth to a healthy baby girl at the Union Hospital Affiliated to Huazhong University of Science and Technology (hereinafter referred to as "Union Hospital"), 4.3 kilograms.

In order to deliver Yuko safely, in addition to the Obstetrics and Gynecology Department, Union Hospital also dispatched multidisciplinary teams such as cardiac and macrovascular surgery, anesthesia department, and operating room to escort the escort. This is not because Yuko is an elderly woman, but because she had a heart transplant 10 years ago.

In 2012, the 27-year-old Xizi went to the Department of Cardiac Macrovascular Surgery of Union Hospital for treatment due to end-stage right ventricular cardiomyopathy, and finally due to severe heart failure, Dong Nianguo's team performed heart transplantation for her.

After the heart transplant, Yuko recovered well and started a family. At the beginning of 2018, Xizi contacted Zhang Jing, the attending physician in charge of perioperative management in the Department of Cardiac And Macrovascular Surgery of Union Medical College Hospital, and expressed her determination to have children.

Although there are cases of pregnancy and childbirth in patients with stable condition after heart transplantation at home and abroad, the risk is still very large. Dong Nianguo introduced that because of the need to take anti-rejection drugs after heart transplantation, even pregnancy can not be interrupted, and most anti-rejection drugs have a certain risk of teratogenicity and miscarriage. In addition, drugs can exacerbate the prevalence of gestational diabetes, gestational hypertension, and increase the workload on the heart.

In order to meet Xizi's desire to have children, Professor Dong Nianguo and Dr. Zhang Jing's team formulated a 2-year "pregnancy preparation plan" for her, adjusted the medication according to her situation, and followed up regularly.

But Yukiko has never been able to get pregnant. "Next month, we'll get the medicine back." Considering Xizi's physical condition, Zhang Jing proposed that she focus on herself and adjust the dose of the medicine to before she was ready to become pregnant.

Just as I was about to give up, the good news came, "Pregnant!" "But the risks of pregnancy come with it.

"There are many challenges during pregnancy, such as congenital thalassemia, gestational hypertension, gestational diabetes, pregnancy complicated by cholestasis syndrome and other problems." Zhao Yin, deputy director of the Department of Obstetrics and Gynecology of Union Hospital, introduced.

After careful treatment and care by the obstetrics and gynecology department, both Yuko and the fetus are in good condition. In the gestational period, obstetrics strengthens obstetric examinations and ultrasound monitoring of the fetus, and to ensure that the impact of anti-rejection drugs on the fetus is minimized, the Department of Cardiac Surgery changes the type of anti-rejection drug for the patient and adjusts the safe dose.

On December 29, when Xizi was 31 weeks pregnant, Zhao Yin organized the MDT consultation of the whole hospital, and jointly conducted a detailed assessment of her condition in multiple disciplines such as cardiac surgery, ICU, anesthesia, operating room, and neonatology, and determined the management plan and emergency plan for late pregnancy.

After strict management, close monitoring, comprehensive evaluation and discussion by the MDT team for pregnancy complicated by cardiovascular system disease, it was decided to continue the pregnancy under close supervision. In order to ensure the safety of the mother and baby, it was finally decided to perform a caesarean section at 36 weeks of pregnancy.

On January 26, at 8:30 a.m., during the Southern Lunar New Year, an epidural anesthesia was administered to Yuko. At 8:45, through the intense and orderly cooperation of multidisciplinary teams such as obstetrics, anesthesiology, and operating room, the amount of bleeding was about 200ml, only 30 minutes, and 4.3 pounds of baby girls fell to the ground, and the child cried loudly, with a score of 8-9 points. After surgery, the mother-daughter vital signs are stable.

"The desire to conceive is understandable, but women with specific medical conditions need to think carefully." Zhao Yin said that women with heart disease, hemophilia, hypertension, diabetes, liver and kidney system diseases, systemic lupus erythematosus and other diseases must do a systematic examination before pregnancy, and a detailed risk assessment by the obstetric multidisciplinary team, because the pregnancy process is likely to lead to aggravation of the disease, and serious will also endanger life.

It is reported that pregnancy with cardiovascular disease is a serious obstetric comorbidity, but also one of the main causes of maternal life threats. The Department of Obstetrics and Cardiac Surgery of Union Medical College Hospital has excellent professional strength and rich experience in treatment.

Over the past ten years, Union Medical College Hospital has carried out more than 900 heart transplants, more than 100 cases of children's heart transplants, and many heart transplant patients have returned to normal life after surgery. As a referral and consultation hospital for obstetric emergency critical diseases and incurable and complicated diseases in hospitals at all levels in the province and central and southern regions, the obstetrics department of the hospital accounts for more than 60% of the patients admitted to the acute and critical illness, and the proportion of difficult diseases is more than 50%, and through multidisciplinary teamwork, the rescue success rate is more than 97%.

(Correspondents: Nie Wenwen, Peng Jinxian, Chen Youwei, Liu Kunwei)

Source of this article: Medical community

Editor-in-Charge: Yuan Xueqing, Zhang Li

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