早发型重度子痫前期终止妊娠时机对母儿结局的影响

Influence of different gestation age on the outcome of maternal and infant in early onset severe preeclampsia

目的：探讨早发型重度子痫前期患者终止妊娠时机、分娩方式的选择及妊娠结局。方法回顾性分析87例早发型重度子痫前期患者临床资料。按照终止妊娠时的孕周分为：A组（＜32周）26例；B组（32～33＋6周）24例；C组（≥34周）37例。所有患者均入院行期待治疗，镇静、解痉、降压等。评估治疗效果，按指征终止妊娠。结果期待治疗时间比较，C组期待治疗时间长于A、B两组（P＜0．05），B、C组剖宫产率高于A组（P＜0．05）；入院时及终止妊娠前的24 h尿蛋白定量值，C组均明显低于A组（ P＜0．05）。 B组、C组终止妊娠前24 h尿蛋白定量明显高于入院首次24 h尿蛋白定量（P＜0．05）；三组间并发症的发生率比较差异无显著性意义（P＞0．05）；出生体重随终止妊娠时的孕周增加而增加，三组间两两比较差异有显著性意义（P＜0．05）；FGR、胎死宫内、胎儿窘迫的发生，三组比较无统计学差异；围产儿死亡率的比较，A组显著高于B、C两组（P＜0．05）。新生儿轻度窒息的比较， A组高于B组，有统计学差异（P＜0．05）。新生儿重度窒息的比较，A组明显高于 B、C两组（P＜0．05）。 B组、C组比较无差异。结论早发型重度子痫前期不良妊娠结局风险增加，在保证母亲安全的前提下尽可能延长孕周可提高胎儿成熟度，从而可以获得较理想的母胎结局。

Objective To study the timing of pregnancy termination, mode of delivery and pregnancy outcomes in patients with early onset severe preeclampsia. Method We retrospectively analyzed 87 patients with early onset severe preeclamp- sia. Objects were divided into three groups according to the time of pregnancy termination ： group A （ less than 32 weeks） 26 cases, group B （32 -33 ＋6 weeks） 24 cases, group C （34 weeks or higher） 37 cases. Results There was significant difference between group C compared to A and B （ P 〈 0. 05 ） in expectant treatment time. Group B, C had higher rate of cesarean section than group A （ P 〈 0.05 ）. In comparison of 24 h urine protein, group C was significantly lower than group A （ P 〈 0.05 ） at admission and before pregnancy termination ; in groups B and C, the 24 h urine protein before pregnancy termination was significantly higher than that at admission （ P 〈 0.05 ）. There was no obvious difference in complications a- mong the three groups （ P 〉 0.05 ）. Birth weight increased with gestational age at the time of pregnancy termination ; the difference was statistically significant among the three groups （ P 〈 0.05 ）. There was no obvious differences in the inci- dence of FGR, fetal intrauterine demise, and fetal distress. The perinatal mortality was significantly different among the three groups （ P 〈 0. 05 ）. In comparison of mild asphyxia in newborn, group A was significantly higher than that of group B （ P 〈 0.05 ） ; whereas group A had significantly higher severe asphyxia in newborn compared to groups B and C （ P 〈 0.05 ）, but there was no difference between group B and C. Conclusion The early onset of severe preeclampsia threatens maternal and fetal health. In the premise of maternal - safety, expectant management results in an ideal maternal - fetal outcome by extending gestational age and improves fetal maturity.