早发型重度先兆子痫期待疗法和母婴结局

Expectant management of early on-set severe preeclampsia and maternal and neonatal outcomes

目的 回顾性研究早发型重度先兆子痫的期待疗法及母婴结局.方法 选取2007年1月～2008年6月于北京妇产医院住院并分娩的329例诊断为重度先兆子痫的孕妇.按入院孕周的不同分为3组：Ⅰ组孕周≤27.6周,27例;Ⅱ组孕周28～33.6周,114例;Ⅲ组孕周≥34周,188例.3组均按入院后48h内是否终止妊娠分为立即终止组和期待组.分析和比较3组间孕妇并发症及围产儿结局.结果 Ⅰ组有22例（81.5%）行期待疗法,期待天数为3～59天,平均为14.5±18.7天,孕产妇并发症发生率为18.2%,围产儿死亡率高达864‰;Ⅱ组有84例（73.7%）行期待疗法,时间为3～12天,平均为9.4±7.1天,孕产妇并发症发生率为34.5%,围产儿死亡率为348‰,明显低于立即终止组（χ^25.149,P〈0.05）.Ⅲ组有62例（33.0%）行期待疗法,时间为3～18天,平均5.1±3.0天,孕产妇并发症发生率为8.1%.Ⅰ组与Ⅱ组期待疗法的孕妇并发症发生率比较无显著性差异,Ⅱ组的围产儿死亡率明显低于Ⅰ组的（χ^218.923,P〈0.05）.Ⅱ组孕妇并发症发生率、围产儿死亡率显著高于Ⅲ组.3组期待天数比较有显著性差异（F=10.735,P〈0.05）,Ⅰ组的期待天数明显高于Ⅱ组（F=5.140,P〈0.05）,Ⅰ组的期待天数明显高于Ⅲ组（F=9.420,P〈0.05）,Ⅱ组的期待天数明显高于Ⅲ组（F=29.780,P〈0.05）.结论 28周以前的重度先兆子痫患者采用期待疗法并未改善胎婴儿结局,发病于34周以后的重度先兆子痫期待疗法不能显著降低围产儿死亡率,故期待疗法意义不大.发病于28～34周的重度先兆子痫行期待疗法可明显降低围产儿死亡率,但期待疗法时间不宜过长.

Objective To retrospectively investigate therapeutic effect of expectant management for pregnant women with early onset severe preeclampsia （EOSP） and maternal and neonatal outcomes. Methods 329 pregnant women who were diagnosed as severe preeclampsia in The Affiliated Obstetrical and Gynecological Hospital of Capital Medical University in a period from January 1st, 2007 to June 30th, 2008 were selected in this study. The pregnant women were divided into three groups according to the gestational weeks at admission： group Ⅰ was defined as the gestational week less than 27.6 weeks（ n = 27） ; group Ⅱ was defined as the gestational weeks between 28 weeks and 33.6 weeks （n =114） and group Ⅲ was defined as the gestational weeks more than 34 weeks （n = 188）. The pregnant women in each group were again divided into two subgroups：immediately delivery subgroup and expectant management subgroup according to whether the pregnant women immediately delivered within 48-hours after admission. Maternal complications and perinatal outcomes were analysed and compared among the three groups. Results In group Ⅰ, 22 pregnant women （81.5%） received expectant management and the average course of expectant management was 14.5 ± 18.7 days （ranged from 3 days to 59 days）. The incidence of maternal complications was 18.2% and the perinatal mortality rate was 864%o. In group Ⅱ , 84 pregnant women （73.7%） received expectant management and the average course of expectant management was 9.4 ± 7.1 days （ ranged from 3 days to 12 days）. The incidence of maternal complications was 34.5% and the perinatal mortality rate was 348%0, which was significantly lower than that in the immediately delivery subgroup （x^2 = 5. 149,P 〈 0.05）. In group Ⅲ, 62 pregnant women （33%） received expectant management and the average course of expectant management was 5.1 ± 3.0 days （ranged from 3 days to 18 days）. The incidence of maternal complications was 8.1% and the perinatal mortality rate was 43‰. No difference in incidence rate of pregnancy complications of pregnant women who received expectant management between group Ⅰ and groupⅡ. The perinatal mortality rate in group Ⅱ was significantly lower than that in the group Ⅰ（x^2 = 18. 923,P 〈 0.05）. The incidence of maternal complications and neonatal mortality rate in group Ⅱ were significantly lower than those in the group Ⅲ. In course of expectant management, there was significant difference among the three groups（ F = 10.735, P 〈0.05 ） ： course of expectant management in group I was significantly longer than that in group Ⅱ （ F = 5.14, P 〈 0.05 ） and group Ⅲ（ F = 9.42, P 〈 0.05 ）, while course of expectant management in group Ⅱ was significantly longer than that in group Ⅲ （ F = 29. 780, P 〈 0.05 ）. Conclusion The expectant management for preeclampsia occurred before 28 gestational weeks cann＇ t change the fetal/neonatal outcomes. The expectant management for late on-set preeclampsia（ occurred after 34 weeks of gestation） cann＇ t significantly improve the mortality neonatal mortality rate, so the significance of expectant management is not important. While the expectant management for preemplasia occurred in 28 - 34 weeks of gestation can significantly lower the neonatal mortality rate, only, the course of the expactant management should not be too long.