期待治疗对不同孕周早发型重度子痫前期妊娠结局的影响

目的探讨对早发型重度子痫前期进行期待治疗的临床意义及妊娠结局。方法对诊断为早发型重度子痫前期的111例患者的临床资料进行回顾性分析,并将患者按照发病时孕周分为3组：A组（≤27＋6周）,B组（28-31＋6周）,C组（32-33＋6周）,比较3组的妊娠结局。结果 （1）早发型重度子痫前期病例发病时间越早,孕产妇并发症越多,3组的并发症病例数分别为：7例（58.3%）,17例（51.5%）,20例（30.3%）,但3组间差异无统计学意义;（2）3组间胎儿窘迫发生率、胎死宫内发生率、新生儿存活率和围产儿死亡率差异有统计学意义,发病越早,围产儿并发症的发生率越高（P〈0.05）;胎儿窘迫发生率A组和B组显著高于C组,胎死宫内发生率A组显著高于B组和C组,围产儿病死率A组显著高于B组和C组,新生儿存活率C组显著高于A组和B组,差异均有统计学意义（P〈0.05）;（3）3组的发病孕周和分娩孕周比较差异均有统计学意义（P〈0.05）。3组中B组的期待治疗时间明显长于A和C组（P〈0.05）;A组和C组间差异无统计学意义。结论早发型重度子痫前期在不同孕周的妊娠结局有差异。对早发型重度子痫前期进行期待治疗可以在保证母体安全的前提下,明显改善围生儿结局。

Objective To determine the clinical significance and the maternal and perinatal outcome after expectant management for patients with early onset severe pre-eclampsia. Methods 111 patients with early onset severe pre-eclampsia admitted were retrospectively investigated. They were divided into three groups according to the onset time of pathogenic week of gestation： group A （〈-27＋6 weeks）, group B （28-31＋6 weeks） and group C （32-33-6 weeks）. The maternal and perinatal outcome of the three groups was compared. Results （1）Earlier the early onset of severe pre-eclampsia occurred, more complications would occur. But the difference was not statistically significant. （2）There were significant differences in the rates of fetal distress, fetal death,neonatal survival and perinatal infant mortality of the three groups. Earlier the pathogenic week, higher rate of complications the perinatat infant would occur （P〈0.05）. （3）The differences of the onset of gestational age and delivery gestational age of the three groups were statistically significant （P〈0.05）. Expectant treatment time of group B was significantly longer than that of the other groups （P〈0.05）. The difference of group A and C was not statistically significant. Gonclusion The difference of pregnancy outcome of different gestational ages with early onset severe pre-eclampsia was statistically significant. Expectant management of early onset severe pre-eclampsia can obviously improve the perinatal outcome on the premise of ensuring the safety of the mother.