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Complications cardiovasculaires de la grossesse et du peripartum

Cardiovascular complications of pregnancy and peripartum

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Réanimation

Résumé

La mortalité maternelle en rapport avec une maladie cardiovasculaire est en augmentation. La grossesse s’accompagne demodifications physiologiques propices à la survenue de la décompensation d’une cardiopathie préexistante, mais peut également être responsable de pathologies acquises de novo. La prise en charge de cardiopathies connues comme les cardiopathies congénitales est fréquente, mais s’accompagne rarement d’un événement grave. Au contraire, les pathologies survenant de novo sont moins fréquentes mais responsables de la majorité des décès. Les principales causes de décès sont la mort subite, l’infarctus du myocarde, la dissection aortique et les cardiomyopathies acquises, en premier lieu desquelles la cardiomyopathie du peripartum. En l’absence d’une prise en charge adéquate, ces pathologies peuvent avoir une évolution rapidement fatale. Leur reconnaissance précoce est donc primordiale, car elle conditionne leur pronostic. Au cours de la prise en charge d’une pathologie cardiovasculaire en réanimation, le pronostic maternel est toujours privilégié par rapport à celui du fœtus. La complexité des situations médicales et la dualité mère-enfant rendent indispensables la coordination multidisciplinaire.

Abstract

Maternal mortality in women with cardiovascular disease is increasing. Pregnancy induces physiological changes resulting in possible decompensation of a preexisting heart disease. However, it could also be associated with a new-onset cardiovascular disease. The treatment of preexisting diseases, such as congenital cardiopathies is common, but is associated with good prognosis. At the opposite, acquired diseases are less common, but responsible for most of deaths. The most common causes of death are sudden arrhythmic death syndrome, myocardial infarction, aortic dissection, amniotic fluid embolism and acquired cardiomyopathies like peripartum cardiomyopathy.Without appropriate treatment, evolution of these pathologies is rapidly fatal. Early diagnosis is essential to improve their prognosis. During the care for the critically ill pregnant, advantage is always given to the maternal prognosis compared to the fetal one. The complexity of care and the duality mother children require a multidisciplinary approach.

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  1. Centre de réanimation, hôpital Roger Salengro, CHRU Lille, rue P. Decoulx, F-59037, Lille, France

    Y. Benzidi & M. Jourdain

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  1. Y. Benzidi
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  2. M. Jourdain
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Correspondence to Y. Benzidi.

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Benzidi, Y., Jourdain, M. Complications cardiovasculaires de la grossesse et du peripartum. Réanimation 24, 152–164 (2015). https://doi.org/10.1007/s13546-015-1042-x

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