重度子痫前期并发腹水的特点及终止妊娠的时机

Clinical characteristics and timing of delivery in women with severe preeclampsia complicated with ascites.

目的:通过分析重度子痫前期并发腹水患者的临床特点,探讨终止妊娠的时机。方法:回顾分析358例重度子痫前期患者的临床资料,根据是否并发腹水分为:腹水组(64例)和非腹水组(294例)。分析两组孕妇一般情况、分娩方式、合并症及并发症(包括子痫、HELLP综合征、肝肾功能不全、心功能不全、低蛋白血症、胎盘早剥、产后出血、产褥感染)。收集两组围产儿(腹水组76例,无腹水组314例)的临床资料,按胎龄分为<32周、32～33+6周、34～35+6周和≥36周,分别比较两组小于胎龄儿(SGA)的发生率和死亡率。结果:(1)腹水组入院孕周和分娩孕周均明显早于无腹水组[入院(31.1±2.2)周vs(35.1±3.1)周],分娩(32.1±2.2)周vs(36.2±1.3)周,P均<0.05)。腹水组系统产前检查率显著低于无腹水组(25.0%和46.3%,P<0.05)。腹水组低蛋白血症(100.0%vs 46.9%)、肝肾功能不全(31.2%vs 8.2%)、HELLP综合征(9.4%vs2.0%)、产后出血(18.8%vs 2.0%)发生率均显著高于无腹水组(P均<0.05)。(2)腹水组围产儿SGA发生率与无腹水组的差异无显著性(60.5%vs 29.3%,P>0.05〉;腹水组不同胎龄围产儿SGA发生率均高于同胎龄无腹水组,但仅胎龄≥36周时差异有统计学意义(77.8%vs 48.2%,P<0.05);腹水组中,胎龄≥36周的围产儿SGA发生率最高(P<0.05)。(3)腹水组围产儿死亡率显著高于无腹水组(31.6%vs 5.7%,P<0.05)。除胎龄34～35+6周组,其余各胎龄组的腹水组围产儿死亡率均显著高于同胎龄无腹水组(P<0.05);腹水组中,胎龄<32周的围产儿死亡率显著高于其他胎龄组(P<0.05)。结论:重度子痫前期并发腹水发病早,并发症多,母儿预后不佳。腹水是重度子痫前期的一个危险信号,应引起产科医生的高度重视。对于重度子痫前期并发腹水者,应实时终止妊娠。

Objective：To investigate the clinical characteristics and the optimal time of delivery in pregnant women with severe preeclampsia complicated with ascites. Methods：A retrospective study was conducted on 358 sever preeclampsia mothers and their 390 neonates,who were divided into two groups：64 complicated with ascites （ascites group ） and 294 without （non-ascites group）. The general conditions, mode of delivery and complications including eclampsia, hemolysis, elevated serum level of liver enzymes, and low platelets （HELLP syndrome） , liver failure, renal failure, heart failure, hypoproteinemia, placental abruption, postpartum hemorrhage and puerperal infection, were also analyzed. Clinical data of all infants （76 from ascites group and 314 from non-ascites group）were analyzed. The incidence and mortality rate of small for gestational age （SGA） in both group within the same gestational age group and those between different gestational age groups in the ascites group were compared. Results： （ 1 ） The average gestations at admission and delivery in the ascites group were earlier than the other [ admission： （ 31.1±2.2 ） weeks vs （ 35. 1± 3. 1 ） weeks; delivery： （ 32. 1 ± 2.2 ） weeks vs （36.2_±1.3） weeks,P〈0.05]. The rate of systemic antenatal care in the ascites groupwas lower than that of the non-ascites group （25.0% vs 46.3%, P〈0.05）. More complications were found in the ascites group than in the non-ascites group （hypoproteinemia ： 100.0% vs 46.9% ;liver and renal failure ：31.2% vs 8.2% ;HELLP syndrome：9.4% vs 2.0% ;postpartum hemorrhage：18.8% vs 2.0% ;all P〈0.05）. （2）The incidence of SGA in the ascites group was all higher than that in the non-ascites group, however, significant differences was only found getational age at ≥ 36 weeks （ 77.8 % vs 48.2 %, P 〈0.05 ）. In the ascites group, neonatal motality significantly higher than non ascites group （31.6% vs 5.7% ,P〈0.05）except 34～35^＋6 weeks, rest of the groups neonatal mortality was significantly higher in ascites groups than non ascites groups at the same getational age（ P〈0.05 ）. In ascites groups, neonatal mortality at less 32 gestational ages was higher than others apparantly （P〈0.05）. Conclusions： The early onset of ascites and higher rate of complications in severe preeclamptic women implies the adverse maternal and fetal outcomes. Ascites in severe preeclampsia cases should alert the clinicians. The optimal time for delivery might be reasonablely.