妊娠期高血压病患者终止妊娠时机及分娩方式临床观察

Clinical observation on the time of termination of pregnancy and method of delivery in pregnant patients with hypertension

目的探讨妊娠期高血压疾病患者的终止妊娠时机及分娩方式对妊娠结局的影响。方法选取本院产科于2011年11月-2013年10月收治的妊娠期高血压疾病孕妇156例，根据终止妊娠时机分为3组：A组（〈34周，22例）、B组（34-36周，41例）、C组（〉36周，93例）；根据分娩方式分为2组：经阴道分娩组（38例）和剖宫产组（118例）。分别对比不同妊娠时机、不同分娩方式新生儿出生体质量、新生儿窒息发生率、新生儿死亡率以及产妇并发症发生率。结果A组新生儿出生体质量显著低于B、C组（P〈0．01），B组显著低于C组（P〈0．01）；A组新生儿窒息发生率及新生儿死亡率显著高于B、C组（P〈0．01或P〈0．05），B组显著高于C组（P〈0．05）。不同终止妊娠时机产妇并发症发生率比较差异无统计学意义（P〉0．05）。经阴道分娩组新生儿出生体质量显著低于剖宫产组（P〈0．01）；而经阴道分娩组新生儿窒息发生率、死亡率以及产妇并发症发生率均显著高于剖宫产组（P〈0．01）。结论孕周较小的妊娠期高血压疾病患者应给予合理的治疗以适当延长妊娠时间，于妊娠36周左右时终止妊娠，并应尽可能选择剖宫产，从而降低经阴道分娩对产妇及胎儿造成的伤害，降低新生儿及产妇围生期并发症发生率。

Objective To discuss the clinical influence of time of termination of pregnancy and method of delivery for pregnancy outcomes in pregnant patients with hypertension. Methods 156 pregnant patients with hypertension were divided into less than 34 weeks group with 22 patients, 34 - 36 weeks group with 41 patients, over 36 weeks group with 93 patients according to the time of the termination of pregnancy, and two groups including vaginal delivery group with 38 patients and cesarean section group with 118 patients according to delivery methods. The birth weight, neonatal asphyxia, neonatal mortality, maternal morbidity were contrasted between the three and two groups. Results The birth weight in the less than 34 weeks group were significantly lower than that the 34- 36 weeks group and above 36 weeks group （P〈0.01）. The 34- 36 weeks group was significantly lower than that in the above 36 weeks group（P 〈 0.01 ）. Neonatal asphyxia and neonatal mortality in the less than 34 weeks group were significantly higher than that in the 34- 36 weeks group and above 36 weeks group（P〈0.01 or P〈0.05）. The 34- 36 weeks group was significantly higher than that in the above 36 weeks group（P〈 0.05）. But the difference was not significant in maternal morbidity in the three groups （ P 〉 0 . 0 5 ） . The birth weight in the vaginal delivery group were significantly lower than that in the cesarean section group（P〈0.01）. And the neonatal asphyxia, neonatal mortality, and maternal morbidity in the vaginal delivery group were significantly higher than that in the cesarean section group （ P 〈 0.01）. Conclusion Pregnancy patients with hypertension in shorter gestational time should be given reasonable treatment to extend pregnancy time. And they should terminate pregnancy at about 36 weeks of pregnancy and operate cesarean section to reduce the damage to the fetal. In this way, neonatal and maternal perinatal morbidity can reduce.