早发型重度子痫前期期待治疗妊娠结局的多因素分析

Multivariate analysis on the pregnancy outcomes after expectant management of early-onset severe pre-eclampsia

目的探讨早发型重度子痫前期期待治疗中母儿不良妊娠结局的独立危险因素。方法对57例经期待治疗的早发型重度子痫前期孕妇的临床资料进行总结分析,按照有无孕妇及新生儿严重并发症（包括新生儿死亡）的发生分别分为孕妇不良妊娠结局组与对照组和新生儿不良结局组与对照组,分别比较两组患者的一般临床情况及各项检验指标。采用多因素Logistic回归分析母儿不良妊娠结局的危险因素。结果57例早发型重度子痫前期期待治疗中,16例孕妇出现严重并发症,发生率为16/57（28.1%）,无孕产妇死亡。胎死宫内3例,12例新生儿出现明显并发症,其中6例新生儿死亡,围产儿死亡率为9/57（15.8‰）。经多因素回归分析,发病孕周（以30周为界）及血小板减少是孕妇严重并发症发生的独立危险因素,比数比分别为5.2（95%CI 1.1-24.0,P=0.04）和4.6（95%CI 1.2-17.6,P=0.03）。分娩孕周（以32周为界）是新生儿病率及死亡率的独立危险因素,比数比为6.0（95%CI 1.5-24.9,P=0.01）。结论早发型重度子痫前期期待治疗中需严密监护。发病孕周不足30周及血小板降低者孕妇严重并发症的发生显著增加,而分娩孕周超过32周,新生儿结局将显著改善,因此需权衡利弊,选择恰当时机终止妊娠。

Objective To investigate the independent high risk factors associated with maternal and neonatal outcomes during the expectant management of early-onset severe pre-eclampsia.Methods Retrospective chart review was conducted on 57 pregnancy women with early-onset severe pre-eclampsia,who underwent expectant management.Patients were divided into maternal adverse outcome group and control group according to major maternal complications.Then they were divided into neonatal adverse outcome group and control group according to major neonatal complications（including neonatal death）.The general clinical characters and laboratory findings were evaluated and compared between each pair of groups respectively.Multiple logistic regression was used to explore the risk factors associated with maternal and neonatal adverse outcome.Results Sixteen（28.1%） pregnancy women developed severe complications during expectant management,with no event of maternal death.Three intrauterine fetal deaths occurred.Six neonates died among the twelve with obvious complications.The overall perinatal mortality was 9/57（15.8‰）.Major maternal complications were related to gestational age of onset（30-week gestation as the cut-off point） and thrombocytopenia.The odds ratio was 5.2（95%CI 1.1-24.0,P=0.04）and 4.6（95%CI 1.2-17.6,P=0.03）,respectively.Neonatal morbidity and mortality were predominantly associated with gestational age of delivery（32-week gestation as the cut-off point）,with odds ratio of 6.0（95%CI 1.5-24.9,P=0.01）.Conclusions Close monitoring is important during expectant management of early-onset severe pre-eclampsia.Gestational age of onset（less than 30 weeks） and thrombocytopenia are independent risk factors for maternal complications,while neonatal outcome is improved after 32-week gestation.Adequate consideration of the benefits and risks is essential,as well as appropriate timing of delivery.