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Objective: To analysis the risk factors for major adverse cardiovascular event (MACE) in pregnant women with valvular heart disease (VHD) and to construct a risk prediction model. Methods: The clinical data of 245 pregnant women with VHD who were hospitalized in Beijing Anzhen Hospital from January 1, 2012, to June 1, 2023 were retrospectively analyzed, including general information, pre-pregnancy and pregnancy-associated cardiac conditions, and MACE. Univariate analysis and logistic regression models were employed to identify risk factors for MACE during pregnancy among pregnant women with VHD. Furthermore, a predictive model was constructed and internal validation was conducted using bootstrap techniques. Results: (1) Among 245 pregnant women with VHD, the incidence of MACE was 18.0% (44/245), and the most common MACE was heart failure (61.4%, 27/44). The mitral valve was the most frequently affected valve (64.9%, 159/245). Prior to pregnancy, the most common type of valve surgery undertaken was mechanical valve replacement, representing 31.4% (77/245) of surgeries. In contrast, among those pregnant women who did not undergo valve surgery before pregnancy, the most common lesion type was mitral regurgitation (17.6%, 43/245). (2) Comparing the maternal and infant outcomes of warfarin, low molecular weight heparin (LMWH) and LMWH sequential with warfarin, the fetal loss rate (36%, 15/42) and malformation rate (7%, 3/42) were the highest, but the MACE rate (12%, 5/42) was the lowest in warfarin group. The fetal loss rate (1/19), malformation rate (1/19) and artificial valve thrombosis rate (0) of LMWH sequential with warfarin were the lowest, and the fetal loss rate and artificial valve thrombosis rate of the three anticoagulation methods were statistically significant (all P <0.05). (3) There were no significant differences in gestational age, age of diagnosis of heart disease, weight at delivery, pre-pregnancy body mass index, proportion of multiparous women and chronic medical history between women with MACE and those without MACE (all P >0.05). (4) Binary logistic regression analysis identified the following as risk factors for MACE during the second trimester of pregnancy among pregnant women with VHD: pre-pregnancy cardiac symptoms, history of corrective surgery for congenital heart disease, pregnancy risk grade Ⅴ, anticoagulation with LMWH during pregnancy, and arrhythmia (all P <0.05). Based on the results of multivariate analysis, a receiver operating characteristic curve was constructed, with an area under the curve of 0.837, indicating good discriminative ability. The calibration plot demonstrated a close alignment between the standard curve and the calibration prediction curve, suggesting excellent calibration of the model. Conclusions: Pregnant women with VHD are at a high risk of experiencing MACE during gestation. Five risk factors, including pre-pregnancy cardiac symptoms, history of corrective surgery for congenital heart disease, pregnancy risk grade Ⅴ, anticoagulation with LMWH, and arrhythmia, could aid in identifying high-risk pregnant women.

Objective: To summarize the characteristics of pregnant women with critical congenital heart disease, and to explore continuous, integrated, multidisciplinary management for this segment of population. Methods: The clinical records of pregnant women with severe congenital heart disease with a history of intensive care who were treated in Guangdong Provincial People's Hospital from January 1, 2008 to December 31, 2020 were retrospectively analyzed. Results: (1) A total of 132 cases were included, including 128 pregnant women [gestational age (28.0±8.8) weeks] and 4 puerpera cases (6-32 days postpartum), 63.6% (84/132) from economic underdeveloped rural areas, and 78.0% (103/132) by the municipal hospital, irregular prenatal examination accounted for 59.1% (78/132). The main type of congenital heart disease was shunt lesion (55.3%, 73/132). 90.9% (120/132) with mWHO risk classification stage Ⅳ were assigned to it. The main cardiovascular complication was pulmonary hypertension (64.4%, 85/132). 46.2% (61/132) of the patients had been diagnosed with congenital heart disease before pregnancy, and 70.5% (93/132) of the patients had not received any treatment before pregnancy. (2) All patients received obstetric-led, multidisciplinary care. The rescue success rate was 96.2% (127/132), and no serious obstetric complications occurred. The mortality within 24 hours after discharge was 3.8% (5/132). 16.7% (22/132) underwent cardiac surgery during pregnancy, of which 77.3% (17/22) continued their pregnancy beyond 34 weeks. Totally, the delivery week was (30.5±8.6) weeks, and the main mode was cesarean section (71.2%, 94/132). The average weight of 99 live births (including 1 twin pregnancy) was (2 167±698) g. Preterm birth, fetal growth restriction, and congenital malformations were the main fetal comorbidities. Conclusions: Pregnant women with severe congenital heart disease mainly come from areas with underdeveloped economic and medical levels. Later disease intervention, pregnancy retention despite of clear pregnancy contraindications are the distinctive features, which leaded to a significant increase of incidence of maternal and fetal complications, and an increase of the consumption of medical resources. Multidisciplinary active treatment and cardiac surgery during pregnancy could relatively improve maternal and fetal pregnancy outcomes.

Objective: To analyze the clinical data of pregnant women complicated with cardiovascular disease in our center in the past 10 years, and to explore the trend of incidence, clinical diagnosis, and treatment of the disease. Methods: Clinical data of pregnant women with cardiovascular disease who delivered in Beijing Anzhen Hospital, Capital Medical University from 2010 to 2019 were collected and analyzed retrospectively. According to the time of the establishment of multidisciplinary team (MDT) in the center, the pregnant women were divided into the first 5-year group (2010-2014) and the second 5-year group (2015-2019). The general data, the composition of pregnancy complicated with cardiovascular disease and the changes of maternal and infant outcomes of the two groups were analyzed. Results: (1) During 2010-2019, there were 2 267 cases of pregnancy complicated with cardiovascular disease (836 cases in the first 5-year group and 1 431 cases in the second 5-year group), with a total incidence of 10.2% (2 267/22 334). Among all kinds of cardiovascular diseases, arrhythmia (41.0%, 930/2 267) and congenital heart disease (38.2%, 865/2 267) were more common. (2) There were 212 cases (25.4%, 212/836) and 426 cases (29.8%, 426/1 431) classified as Ⅲ or Ⅳ by modified WHO cardiovascular risk classification in the first 5-year group and the second 5-year group, respectively, and the difference was statistically significant ( χ ² = 5.076, P= 0.024). Among all kinds of cardiovascular diseases, there were 111 cases (13.3%, 111/836) and 159 cases (11.1%, 159/1 431) with valvular disease in the first 5-year group and the second 5-year group, respectively. The change of the component ratio was -16.5% (the difference was significant when the absolute value of change>10%), showing a significant decreasing trend. Aortic disease was found in 16 cases (1.9%, 16/836) and 56 cases (3.9%, 56/1 431), respectively, with a significant upward trend of 105.3%. (3) The mortality rate of pregnant women with cardiovascular disease was 1.0% (22/2 267), and 1.2% (10/836) and 0.8% (12/1 431) in the first 5-year grouop and the second 5-year group, respectively. There was no significant difference between the two groups ( χ²= 0.702, P= 0.402). ICU occupancy rates in the first 5-year group and the second 5-year group were 25.6% (214/836) and 20.7% (296/1 431), respectively, and the difference between the two groups was statistically significant ( χ²= 7.306, P =0.007). There were no significant differences in cesarean section rate, mortality rate and incidence of adverse events between the two groups of pregnant women, and there were no significant differences in birth weight, preterm birth rate, mortality rate and asphyxia rate between the two groups of newborns (all P >0.05). Conclusions: Pregnancy complicated with cardiovascular disease is a common cause of adverse obstetric outcomes. There are various types of specific cardiovascular diseases, and the prognosis varies greatly. In recent years, the disease composition ratio has changed, and the severity and complexity of diseases have increased. Hierarchical management, MDT and individual management could improve the treatment level and reduce adverse outcomes.

Objective: To investigate and analyze disease status and risk factors of venous thromboembolism (VTE) during pregnancy and puerperium in our country. Methods: Clinical datas were collected from 575 patients diagnosed with VTE during pregnancy and puerperium and hospitalized in nine medical institutions in our country from January 1, 2015 to November 30, 2019, and retrospectively analyzed it's disease status and risk factors. Results: (1) The proportion of VTE in pregnancy and puerperium was 50.6% (291/575) and 49.4% (284/575), respectively. Four patients died, the mortality rate was 0.7% (4/575). The cause of death was pulmonary embolism. (2) The location of VTE during pregnancy and puerperium was mainly in the lower limb vascular (76.2%, 438/575), followed by pulmonary vessels (7.1%, 41/575). (3) In the risk factors of VTE, cesarean section accounted for 32.3% (186/575), maternal advance age accounted for 27.7% (159/575), braking or hospitalization during pregnancy accounted for 13.6% (78/575), other risk factors accounted for more than 5% were previous VTE, obesity, preterm birth, assistant reproductive technology conception and so on, pre-eclampsia and multiple pregnancy accounted for 4.9% (28/575) respectively. In addition, some patients with VTE did not have any of the above risk factors, and the incidence rate was as high as 23.1% (133/575). Conclusions: The occurrence of VTE during pregnancy and puerperium is related to multiple risk factors, and could lead to matemal death, It is very necessary to screen VTE risk factors for all pregnant women, to make corresponding prevention and control measures.

Objective: To analyze the effect of maternal age on pregnancy outcome in patients with structural heart disease. Methods: Totally 986 patients diagnosed with structural heart disease who had their delivery at Renji Hospital from January 1st, 2003 to December 31st, 2016 were divided into 5 groups according to maternal age. Sixteen (1.6%) were in age group <20 years, 204 (20.7%) were in age group 20-24 years, 461 (46.8%) were in age group 25-29 years, 222 (22.5%) was in age group 30-34 years and 83 (8.4%) was in age group ≥35 years. The incidence of cardiac, obstetric and fetal complications among these groups were analyzed. Results: Among the 986 patients with structural heart disease, 82 (8.3%) experienced adverse cardiac events (some patients had more than 1 complication) , including infective endocarditis (0.4%, 4/986) , malignant arrhythmia (3.3%, 33/986) , heart failure (5.3%, 52/986) , cardiac death (0.9%, 9/986) . The incidence of cardiac complications were respectively 12.5%,11.3%,4.8%,10.4% and 14.5% in each age group, with statistically significant differences when compared with one another ( P= 0.004) . There was no statistically significant difference in the incidence of obstetric complications ( P> 0.05) . The incidence of fetal complications in each group showed statistically significant differences ( P= 0.001) ; which was 25.0%,30.4%,24.1%,29.3% and 47.0% respectively. Conclusions: Age group 25- 29 years presented the lowest risk of cardiac complications and is potentially the optimal age for pregnancy and delivery. Age group <20 or ≥35 years is at higher risk for cardiac complications. The highest rate of fetal complications is in age group ≥35 years.

Objective: To investigate the factors that affect the outcome of pregnancies complicated with critically heart disease admitt ed to obstetric Intensive Care Unit (ICU)., Methods: A retrospective study was conducted for 188 pregnant and postpartum patients complicated with heart disease who were admitted to the ICU in West China Second University Hospital from July 2009 to March 2013., Results: During the 4 years, there were 619 cases of pregnancy complicated with heart disease hospitalization. Among them, 188 (30.37%) patients complicated with severe heart disease were admitted to the ICU, accounting for 39.17% of the total ICU admission (480); the mean maternal age was (28.45 ± 6.08) years old and the mean gestational time was (36.03 ± 4.19) weeks. 23 (12.23%) patients received regular antenatal care in our hospital. 61 (32.45%) patients never received antenatal care before hospitalization. Among them, 5 patients were dead. The ratio for diagnosis of heart disease before pregnancy, during pregnancy and after admission were 39.89%, 25.54% and 34.57%, respectively; the most common heart diseases during pregnancy were congenital cardiac disease (80, 42.55%) and rheumatic heart disease (45, 23.94%) followed by arrhythmias (20, 10.64%). The most common complication were pulmonary arterial hypertension (51, 27.13%), arrhythmias (47, 25.00%) and severe heart failure (30, 15.96%); the cardiac function of 164 (87.23%) patients was at stage I-II and 5 (2.66% ) patients died when discharged from hospital. 151 (80.32%) patients received multidisciplinary consultation and 34 (18.09%) used central venous catheterization to control central venous pressure (CVP). 21 (11.17%) patients required mechanical ventilation. 11 (5.85%) patients required emergency life support (cardiopulmonary resuscitation 9 + electric defibrillation 3)., Conclusion: Pregnancy complicated with heart disease is the leading reason for admission to ICU. The congenital cardiac disease, rheumatic heart disease and arrhythmias are the main heart diseases during pregnancy. Multidisciplinary cooperation and intensive care are the key measures to improve the outcomes of patients with critically illness. It is very important for reduction of the maternal mortality rate through strengthening preconception care and antenatal care.

Objective: To investigate the risk factors for postpartum cardiac events in pregnant women with heart diseases and to provide prenatal counseling for them., Methods: A retrospective analysis was made in cases of pregnant women with heart diseases admitted to the surgical intensive care unit (SICU) of Anzhen Hospital from May 2004 to May 2012. Data were used to identify univariate and multivariate predictors for postpartum cardiac events., Results: A total of 190 patients ( ≥ 20 weeks gestation) were enrolled in the study with 134 (70.5%) of congenital heart disease, 30(15.8%) of rheumatic heart disease, 10 (5.3%) of cardiomyopathy, 2 (1.1%) of peripartum cardiomyopathy and 14 (7.4%) of hypertensive heart disease. Postpartum cardiac events were observed in 42 cases with the incidence of 22.1%. A total of 7 cases resulted in death with the mortality rate of 3.7%. Among them, 5 cases were dead of circulatory collapse and pulmonary hypertensive crisis postpartum, while the other 2 cases with secondary pulmonary infection were died of respiratory and circulatory collapse. The baseline parameters of New York Heart Academy(NYHA)>1, left ventricular ejection fraction(LVEF)<50%, use of cardiac drugs and pulmonary artery hypertension (PAH)>80 mm Hg(1 mm Hg = 0.133 kPa) were the independent predictors for postpartum cardiac events by univariate and multivariate logistic regression analysis., Conclusions: The incidence of postpartum cardiac events is high in pregnant women with heart diseases. Pulmonary artery hypertension and heart failure are the main causes of death.

Objective: To discuss the clinical features of pregnant women with hypertrophic cardiomyopathy (HCM)., Methods: There were 28 patients with HCM who delivered in Renji hospital of Shanghai Jiaotong University from January 2000 to August 2012. Clinical data were analyzed, including diagnosis, cardiac functional grading, gestational weeks of delivery, delivery mode, birth weight, Apgar scores, etc., Results: (1) Of all the 28 patients, 14 (50%) were diagnosed before pregnancy and others (50%) were diagnosed during pregnancy.(2) Four cases were obstructive HCM (14%), 3 with cardiac function grade I and 1 with grade II. Twenty four cases were non-obstructive HCM (86%), 14 with cardiac function grade I, 9 with grade II and 1 with grade IV. (3) Of all the 28 patients, 4 had family history, 18 (64%) had clinical symptoms or signs which occurred in 8-32 gestational weeks. Twenty-three cases had abnormal ECG (82%). Among them 21 had non-obstructive HCM (88%), with average interventricular septal thickness of (22 ± 3) mm. The other 2 patients had obstructive HCM, with average interventricular septal thickness of (23 ± 4) mm.7 patients (7/28, 25%) had mild-to-moderate pulmonary hypertension [6 with non-obstructive HCM (6/24, 25%) ], and 10 patients had abnormal myocardial enzyme spectrum or troponin levels [9 with non-obstructive HCM (9/24, 38%) ].(4) Among all the patients, only one had vaginal delivery and others received cesarean section. Twenty-two patients had term pregnancies and 6 had preterm birth. The average gestational weeks of delivery in non-obstructive HCM and obstructive HCM were (36.5 ± 2.5) and (38.5 ± 0.4) weeks, respectively. The average birth weight of neonates were (2684 ± 563) and (3164 ± 321) g, and Apgar scores were 9.9 and 10 (10 minutes) respectively. Patients transferred to NICU after delivery were 8 and 0. There was 1 maternal death (with non-obstructive HCM whose ejection fraction was only 26%) and no perinatal death., Conclusions: More attention should be paid to the clinical signs and abnormal ECG.HCM could be definitely diagnosed by timely echocardiography. Patients with hypertrophic cardiomyopathy were mainly non-obstructive HCM, with cardiac function grade I and II. Monitoring the change of ejection fraction during pregnancy would help. Perinatal outcomes were fine.

Objective: To compare the differences and similarities between the diagnostic criteria of obstetrics and internal medicine in China with that of Hibbard for peripartum cardiomyopathy (PPCM)., Methods: From March 1995 to September 2009, a total of 49 patients were diagnosed as PPCM at the Peking University People's Hospital and the Fu Wai Hospital in Beijing, China. Obstetric diagnostic criteria was: PPCM was one of dilated cardiomyopathy, occurred during the third trimester of pregnancy through the 6th month postpartum, and without cardiovascular diseases before. Internal medicine diagnostic criteria was: PPCM was unexplained cardiomegaly and heart failure, occurred during the last month of pregnancy through the 5th month postpartum, and meet the echocardiographic criteria of dialated cardiomyopathy as follows:left ventricular end-diastolic dimension (LVEDd) greater than 5.0 cm; left ventricular ejection fraction (LVEF) less than 45%, and(or) left ventricular fractional shortening (LVFS) less than 30%; or LVEDd greater than 2.7 cm/body surface area (m2); or LVEDd>117% of age and body surface area predictive value. Hibbard diagnostic criteria was: All four of the following: (1) heart failure within last month of pregnancy and 5 months postpartum; (2) absence of prior heart disease; (3) no determinable cause; (4) strict echocardiographic indication of left ventricular dysfunction: LVEF less than 45%, and/or LVFS less than 30%, and LVEDd greater than 2.7 cm/m2. The compliance between obstetric and internal criteria with Hibbard criteria, and the reasons of incompliance between Chinese and international criteria were analyzed., Results: Eight patients were diagnosed of PPCM by obstetricians according to Chinese obstetric criteria. Among them, 6 patients (6/8) did not meet Hibbard criteria.2 of the six did not reach the time regulated in the criteria. All of the six had other determinable causes for heart failure, and their echocardiographic results did not meet the diagnostic standard either. The other 41 patients were diagnosed of PPCM by physicians according to Chinese internal medicine criteria. Among them, 7 patients (17%) did not meet Hibbard criteria, 3 of the seven did not reach the time regulated in the criteria, and had other determinable causes for heart failure either.4 of the seven did not meet the echocardiographic standard part in the criteria. The Chinese internal medicine diagnostic criteria has a significant higher coincidence rate with Hibbard criteria, compared to Chinese obstetric criteria (83% vs. 25%; P<0.01). Among all 13 patients whose PPCM diagnosis did not meet Hibbard criteria, 5 cases did not reach the time regulated in the criteria, 9 cases had other determinable causes for heart failure, and 10 cases did not meet the echocardiographic standard part in the criteria. Preeclampsia was the most common determinable causes for heart failure, accounted for 7 cases., Conclusion: There is obvious difference between Chinese and Hibbard diagnostic criteria for PPCM, especially Chinese obstetric criteria.

Objective: To analyse incidence of the severe complications of hypertensive disorder complicating pregnancy and the influence on the outcome of pregnancy., Methods: A retrospective study of 4107 cases among 71 020 cases who delivered in hospitals from 1995 to 2004 in Guangzhou was conducted., Results: The morbidity of hypertensive disorder complicating pregnancy was 5.78%, in which the morbidity of severe pre-eclampsia was 27.78% (1141/4107), of mitis pre-eclampsia was 72.22% (2966/4107). Maternal mortality rate was 0.19% (8/4107), and the specific mortality rate was 11.26/100 000. The proportion of severe complications of hypertensive disorder complicating pregnancy from high to low was as follows: placental abruption 1.68% (69/4107), DIC 1.36% (56/4107), hypertensive disorder complicating pregnancy induced cardiopathy (induced cardiopathy) 1.05% (43/4107), renal failure 0.97% (40/4107), cerebrovascular accident 0.58% (24/4107), and hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome 0.51% (21/4107). Mortality caused by severe complications of hypertensive disorder complicating pregnancy were as follows: cerebrovascular accident 17% (4/24), HELLP syndrome 10% (2/21), DIC 5% (3/56) and induced cardiopathy 2% (1/43). The proportion of perinatal mortality from severe complications were as follows: placental abruption 43% (33/77), HELLP syndrome 42% (10/24), DIC 34% (22/64), renal failure 25% (11/44), cerebro vascular accident 24% (6/25) and induced cardiopathy 16% (8/49)., Conclusions: (1) The morbidity of severe complications from high to low are: placental abruption, DIC, induced cardiopathy, renal failure, cerebro vascular accident and HELLP syndrome. (2) The main causes of mortality for gravida and puerperant are: cerebro vascular accident, HELLP syndrome, DIC and induced cardiopathy. (3) The major complications harmful to perinatal newborns are in the order of: placental abruption, HELLP syndrome, DIC, renal failure, cerebro vascular accident and induced cardiopathy.

Objective: To study the relationship between human leucocyte antigen (HLA), parents' sharing rate and the incidence of pregnancy induced hypertension (PIH), and investigate its immunopathogenetic roles to severe PIH., Methods: Newborn's and their parents' peripheral blood DNA was extracted and HLA phenotypes were studied by sequence-specific primers polymerase chain reaction (SSP-PCR) in 57 with PIH and 46 normal pregnancy., Results: The frequency of DRB1 * 0306, DRB1 * 0405, DRB1 * 0315, DRB1 * 0403, DRB1 * 1304, QB1 * 03032/33, DQB1 * 0502 in women with PIH was increased significantly and the frequency of DRB1 * 0407, DRB1 * 0317, DQB1 * 05031 were lower than controls. And the risk to PIH of women with DRB1 * 0306, DRB1 * 0405, DQB1 * 0502 were higher than others (RR: 9.76, 6.34, 4.20), and its gene-frequency was higher than controls (P < 0.01). Frequency of DQB1 * 0502, DRB1 * 0405 in PIH's newborns were higher than controls (P < 0.05), but DRB1 * 1304, DQB1 * 05031 were lower than controls, with significant difference (P < 0.05); The gene-frequency of fathers of the two groups weren't different. The HLA sharing rate of mothers or fathers of the two groups weren't different. But that of mother-fetus was higher in PIH than controls. Two locus alleles of PIH group constructed haplotype, and the DRB1 * 0315-DQB1 * 0502, DRB1 * 0405-DQB1 * 06012 antibody was positive with hypertension and protenuria (P < 0.05)., Conclusion: PIH is associated with HLA, and the over expression of HLA genes was a severe cause of PIH.

Objective: To investigate the incidence of pregnancy induced hypertension (PIH) in Shanghai during 1989-1998., Methods: The data were analyzed retrospectively from three municipal general hospitals and five special hospitals obstetrics and gynecology., Results: There were 158,790 deliveries in ten years. The total numbers of PIH were 8,852 cases. The incidence of PIH was 5.57%. The rate of mild, moderate and severe PIH was 55.83%, 29.39%, and 14.78% respectively. There were 114 cases (1.29%) complicated with eclampsia. The rate of cesarean section was 66.97% in PIH patients. The complications of PIH were as following: abruptio of Placenta 0.52%, heart failure 0.34%, renal failure 0.20%, DIC 0.07% hemolysis, elevated liver enzymes and low platelet count(HELLP) syndrome 0.03%, maternal death one case. There were 9,197 birth of 8,852 cases of PIH (twin 343 cases, triplets one cases). The perinatal death 66 occurred in cases (7.18@1000) in which fetal death 48 cases, stillbirth 12 and neonatal death 6., Conclusion: The incidence of PIH and the rate of perinatal infant death can be reduced by strengthen antenatal monitoring, prevention, early diagnosis and treatment of PIH.

Objective: To investigate the changes of pregnancy complicated by heart disease., Method: Clinical data of hospitalized pregnant women with heart disease, collected from 10 teaching hospitals in Shanghai during 1981-1995, were analysed retrospectively., Results: 2,680 of 379,065 deliveries (0.71%) were complicated by heart disease during that period. There were a total of 121 maternal deaths, 15 of them due to heart disease, the mortality of heart disease was 0.56%, and the percentage in total maternal deaths was 12.40%. The incidence and mortality rates were similar in 1981-1985, 1986-1990, 1991-1995, but the percentage due to heart disease increased after the late 1980s. The rates of congenital heart disease increased and rhumatic heart disease decreased apparently, the ratio of the former to the latter was 1.76:1. The pregnancy induced hypertension heart disease, the peripartum cardiomyopathy and the miscellaneous heart disease all increased obviously during the 1990s. The heart functions of grade I and II accounted for a considerable proportion (85.45%), but the grade IV tended to increase during the 1990s. Heart failure occurred in 172 cases, with an incidence of 7.6%. The perinatal mortality rate was 7.76%. Cesarean sections were often performed in heart disease women., Conclusion: Pregnancy complicated by heart disease is still one of the major cause of maternal deaths up till now. More effective management should be adopted.

Epidemiologic investigation and study were made on peripheral vascular diseases in Shanghai area during 1988 and 1989. The total number of examined subjects was 30,712, including peasants and workers from heavy and light industries. The number of the subjects suffered from peripheral vascular diseases was 2,679, with an incidence of 8.72%. Among them, varicosity of the superficial veins in the lower extremities was found in 2,577, and other peripheral vascular diseases were found in 102. Risk factors for varicose veins include hard labour, body mass, standing, pregnancy and sitting. New concepts about the varicose veins were advanced by the authors.