重度子痫前期合并胎儿生长受限的临床分析

A clinical analysis of severe preeclampsia complicated with fetal growth restriction

目的 探讨重度子痫前期合并胎儿生长受限的相关因素及妊娠结局。方法 回顾性分析1996年1月～2006年6月住院并分娩的164例重度子痫前期患者的临床资料。根据有无合并胎儿生长受限分为：胎儿生长受限组和对照组进行比较。结果 胎儿生长受限组：①发生重度子痫前期的孕周为32．1±0．9，显著早于对照组的36．5±0．3（P〈0．05）：②出现脐动脉血流收缩期末峰值、舒张期末峰值之比值异常的孕周为24周，早于对照组的34周（P〈0．05）．胎盘病理检查异常率83％，高于对照组的35％，（P〈0．05）；③出现胎儿宫内窘迫（76．92％和39．13％）较对照组显著增加（P〈0．05），④新生儿重度窒息（46．15％）、肺透明膜病（61．53％）、新生儿死亡（23．07％）的发生率明显高于对照组的13．76％、28．26％、2．89％（P〈0．05）。结论 重度子痫前期合并胎儿生长受限的围产结局较差，为改善母婴预后，应积极预防．早期发现、合理治疗妊娠期高血压疾病。

Objective To investigate risk factors and outcomes of pregnant women with severe preeclampsia complicated with fetal growth restriction （FGR）. Methods The clinical data of forty-one pregnant women with severe preeclampsia complicated with FGR and 123 pregnant women with severe preeclampsia and normal neonatal birth weight at the same time （Control group） who delivered in our hospital from Jan. 1996 to Jun. 2006 were reviewed. The patients were divided into two groups： FGR group and control group （no-FGR group）. Results The FGR group was different from the control group in some aspects： （1） The gestation age when the pregnant women with FGR developed preeclampsia was earlier than that of the pregnant women in the control group（P 〈0.05） ; （2） The gestation age when abnormal S/ D ratio in uhrasonography for umbilical artery flow was found was earlier than that in the control group, and the abnormal rate of placental pathohistological results was higher than that in the control group （ P 〈 0. 05 ） ; （3）The incidences of placental abruption, intrauterine fetal distress, premature delivery were much more than those in the control group （ all P 〈 0.05 ） ;（4）The incidences of neonatal asphyxia, hyaline membrane disease and neonatal death were significantly higher than those in the control group （ all P 〈 0. 05 ）. Conclusion The perinatal outcomes of severe preeclampsia complicated with FGR are poor. To improve the outcomes of maternity and the infant, it is very important to actively prevent, early identify and reasonably treat hypertension disorder complicating pregnancy.