单胎重度子痫前期并发HELLP综合征终止妊娠时机对母婴结局的影响

Influence of pregnancy termination timing on maternal and infant outcomes in severe preeclampsia complicated by HELLP syndrome with single birth

目的 探讨终止妊娠时机对重度子痫前期并发HELLP综合征患者母婴结局的影响.方法 回顾性分析我院收治的44例重度子痫前期并发HELLP综合征的单胎妊娠患者的临床资料,根据确诊至终止妊娠时间的不同分为三组,A组确诊24h内终止妊娠14例,B组确诊24-48h终止妊娠14例,C组确诊48 h后终止妊娠16例,比较分析三组产妇和新生儿并发症发生率及临床死亡率的差异.结果 A组产妇胎盘早剥、心力衰竭、急性肾衰竭的发生率和新生儿呼吸窘迫、窒息的发生率均明显低于B、C组,B组则明显低于C组,差异有统计学意义（P＜0.05）;三组产妇的临床死亡率分别为7.14％、14.28％、18.75％,新生儿死亡率分别为14.28％、21.42％、37.5％,差异有统计学意义（P＜0.05）.结论 重度子痫前期合并HELLP综合征易导致胎儿发育受限和产妇并发症发生率升高,严重威胁母婴的生命安全,较早终止妊娠对于争取良好的母婴结局具有重要的临床价值.

Objective To investigate the effect of pregnancy termination timing on maternal and infant outcomes in severe preeclampsia complicated by HELLP syndrome.Methods Retrospectively analyzed clinical data of 44 cases of severe preeclampsia complicated by HELLP syndrome with single birth in our hospital.The patients were divided into three groups according to the time from definite diagnosis to pregnancy termination：group A,pregnancy termination within 24 h after definite diagnosis,14 cases;group B,pregnancy termination in 24-48 h after definite diagnosis,14cases;group C,pregnancy termination 48 h after definite diagnosis,16 cases.Compared the incidence of complications and the mortality of maternal and infant among three groups.Results The incidence of placental abruption,heart failure,and acute renal failure in the maternal and the incidence of respiratory distress and asphyxia in the infant of group A were significantly lower than those of group B,C,and those of group B were significantly lower than those of group C,with statistically significant differences （P〈0.05）.The maternal mortality of three groups were 7.14%,14.28%,18.75%,and the neonatal mortality of three groups were 14.28%,21.42%,37.5%,with statistically significant differences （P〈0.05）.Conclusions Severe preeclampsia complicated by HELLP syndrome can lead to fetal growth restriction and maternal complication rate increased,threaten the safety of maternal and child.Early pregnancy termination can achieve better maternal and fetal outcomes.