妊娠高血压产妇临产前凝血系统的变化对妊娠结局的影响及与早产的关系研究

Study on the influence of changes in blood coagulation system on the outcome of pregnant women with gestational hypertension and the relationship with premature labor

目的分析研究妊娠高血压产妇临产前凝血系统变化对妊娠结局的影响度及与早产的关系。方法选取2014年4月至2016年5月进行产检生产的49例妊娠高血压产妇作为观察组,同时选取同时期产检生产的49例健康孕妇作对照组,对两组孕妇凝血功能进行检查,对比分析两组孕妇妊娠结局、剖宫产率和早产率。结果对照组孕妇孕28周和临产前各项凝血功能指标均无明显变化(P>0.05),观察组孕28周时纤维蛋白原(Fg)及D二聚体(D-D)水平较对照组明显升高(P<0.05),凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、凝血酶原Ⅲ(AT-Ⅲ)水平则较对照组明显降低(P<0.05)。观察组临产前Fg及D-D水平较孕28周时明显升高,PT、APTT、TT、AT-Ⅲ水平则明显下降,观察组新生儿体重明显低于对照组(P<0.05),新生儿窒息率、胎儿窘迫率及围生儿死亡率则明显高于对照组(P<0.05),观察组孕妇剖宫产率及早产率均明显高于对照组(P<0.05)。结论妊娠高血压产妇临产前凝血系统异常变化可导致不良妊娠结局,且剖宫产率和早产率也明显升高。

Objective To analyze the changes in blood coagulation system during maternal labor in preganant woment with gestational hypertension on the outcome of pregnancy and close relationship with preterm birth. Methods A total of 49 patients with gestational hypertension in this hospital for labour during April 2014 to May 2016 were allocated in observation group,and 49 healthy pregnant women for labour in this hospital at the same period were selected as control group. The indexes of blood coagulation functions of patients in these 2 groups were examined,and the outcomes of pregnant women in these 2 groups were compared and analyzed. Results The indexes of blood coagulation function in pregnant women in control group before 28 th week of gestation were not significantly changed（ P 〉 0. 05）. Levels of Fg and D-D at 28 th week of gestation in observation group were obviously higher than those of control group（ P 〈 0. 05）,and the levels of PT,APTT,TT and AT-Ⅲ were significantly lower than those of control group（ P 〈 0. 05）. Levels of Fg and D-D in observation group before labor were significantly increased at 28 th week of pregnancy,levels of PT,APTT,TT and AT-Ⅲ were obviously decreased. The neonatal weight in control group was significantly higher than that of observation group（ P 〈 0. 05）. The incidence rates of neonatal asphyxia,fetal distress and perinatal death were significantly lower in observation group（ P 〈 0. 05）,the rates of cesarean section in pregnant women and preterm birth in observation group were significantly higher than those of control group（ P 〈 0. 05）. Conclusion The changes in blood coagulation system in pregnant women with gestational hypertension can result in the occurrence of adverse pregnancy,and rate of cesarean delivery and preterm birth were also significantly increased.