精神疾病孕产妇123例分析

Analysis of 123 clinical cases of psychotic patients during pregnancy and parturition

目的:探讨精神病孕产妇妊娠期病情变化、妊娠结局与治疗方法。方法:回顾性分析2003年1月～2008年12月洛阳市第五人民医院收治的123例合并精神疾病的孕产妇临床资料。结果:精神疾病复发者,妊娠期为50例(40.65%),产后为47例(38.21%);妊娠后因病情复发或加重行治疗性流产12例(9.75%),治疗性引产24例(19.51%),稽留流产4例(3.25%),早产2例(1.62%),足月妊娠81例(65.85%);稳定期的54例患者中,阴道分娩36例(66.66%),因产科原因行剖宫产18例(33.33%);29例发作期患者中,因精神症状不合作或用药控制症状效果欠佳行剖宫产19例(65.52%),因产科原因行剖宫产5例(17.24%),阴道分娩5例(17.24%);83例新生儿情况良好,未见畸形。结论:妊娠与分娩可导致精神疾病复发;精神疾病患者妊娠中晚期维持治疗很有必要,必要时需终止妊娠;对发作期患者可放宽剖宫产指征,以保证母婴安全;产后应及时、足量恢复应用抗精神病药。

Objective：To analyze the endings and explore the treatments for the psychotic patients during pregnancy and parturition.Methods： Retrospectively analyzed the clinical cases of 123 psychotic patients during pregnancy and parturition in our hospital during the period from Jan 2003 to Dee 2008.Results：Of the psychotic patients in re-paroxysm, 50 of them in the period of pregnancy （40.65%）, and 47 after parturition （38.21%）;the psychotic patients in re-paroxysm or under further treatments because the patient＇s condition became worse in the period of pregnancy,such treatments caused 12 abortions（9.75%）,24 induced abortions （19.51%）,4 missed abortions （3.25%）,2 premature delivery （1.62%）,81 full-term birth （65.85%）; among 54 patients in stationary phase, 36 of them gave birth through their vaginas（66.66%）, 18 through caesarean operation because of the iatrical caesarean operation index （33.33%）; among 29 patients in paroxysm, 19 patients gave birth through caesarean operation because of their mental disorders or less effective medico-treatment （65.52%）, 5 because of the iatrical caesarean operation index（17.24%）, 5 through their vaginas（17.24%）; 83 neonates were in good condition, no abnormality observed.Conclusion：Actions of pregnancy or parturition by psychotic patients can lead to re-paroxysm of mental disorder; it is important for a psychotic patient in medium-and-later period of her pregnancy to keep antipsyehotics therapy, and to be terminated pregnancy if necessary; for the patient in paroxysm,the indication for caesarean operation could be more flexibly to ensure the safety of the mother and her child;she should be resumed to take sufficient antipsychotics timely after parturition.