早发型重度子痫前期期待治疗的预后评估

EXPECTANT TREATMENT OF EARLY ONSET SEVERE PREECLAMPSIA:AN ASSESSMENT OF ITS PROGNOSIS

目的探讨早发型重度子痫前期期待治疗对母儿结局的影响。方法对我院收治的经期待治疗的280例早发型重度子痫前期病人临床资料进行回顾性分析。将病人按发病孕龄分为4组:Ⅰ组40例,发病孕龄<28周;Ⅱ组68例,发病孕龄28～29+6周;Ⅲ组77例,发病孕龄30～31+6周;Ⅳ组95例,发病孕龄32～33+6周。比较各组孕妇期待治疗时间、并发症发生情况及围生结局。结果 4组孕妇期待治疗时间差异有显著性(F=23.44,P<0.05);4组并发症发生率差异无显著性(χ2=5.607,P>0.05);4组围生儿死亡率随孕周增加而下降,各组间比较差异有显著性(χ2=15.739～104.239,P<0.01);Ⅰ组终止妊娠方式以阴道分娩为主,其他3组以剖宫产为主,Ⅰ组与其他3组剖宫产率比较差异有显著性(χ2=36.487～74.859,P<0.01)。结论早发型重度子痫前期期待治疗是可行的,但应在严密监测母儿状况的同时,选择适宜时机终止妊娠,终止妊娠的主要方法是剖宫产。

Objective To explore the influence of expectant management on mother and fetus of early-onset severe preeclampsia(EOSP).Methods A retrospective analysis was carried out in 280 patients with EOSP received expectant management in our hospital,who were divided into four groups according to gestational age(GA) when onset of the disease: group Ⅰ,GA of <28 weeks;group Ⅱ,68 cases with GA of 28-29+6 weeks;group Ⅲ,77 cases with GA of 30-31+6 weeks;group Ⅳ,95 cases with GA of 32-33+6 weeks.The time of expectant therapy,complications and the perinatal outcomes among the four groups were compared.Results The time of therapy among the four groups was significantly different(F=23.44,P<0.05);the difference of complications among them was not significant(χ2=5.607,P>0.05);the perinatal mortality rate decreased along with the increase of gestational weeks(χ2=15.739-104.239,P<0.01);the main modes of termination of pregnancy were vaginal delivery in group Ⅰ;cesarean sections in the other three groups,the differences between group I and the other three groups were significant(χ2=36.487-74.859,P<0.01).Conclusion The expectant management is feasible for EOSP,but the status of mother and fetus should be closely monitored.It is a must to select an optimal occasion for termination of pregnancy,uterine-incision delivery being the main method.