妊娠合并精神障碍48例临床分析

Clinical analysis of 48 pregnant women complicated with mental disorder

目的探讨妊娠合并精神障碍患者的临床特点及处理策略。方法收集48例妊娠合并精神障碍患者的临床资料,分析其发病年龄、孕次、孕周、终止妊娠方式及妊娠结局。结果 48例妊娠合并精神障碍患者年龄集中于20~34岁(85%),尤其23~30岁(63%)。初产妇(77%)比经产妇(23%)多见,且初次妊娠者(60%)多于再次妊娠者(40%)。住院患者孕周呈两极分布,以妊娠早期(尤其≤10周,占35%)及妊娠晚期(尤其≥37周,占38%)为主。48%患者的精神症状发作于妊娠早期。放弃妊娠29例、阴道分娩3例、剖宫产16例;共分娩新生儿19例,体质量2.5~4.3 kg,新生儿阿普加评分1 min 8~10分、5 min均10分,仅1例为早产儿。结论产科医师应加强对妊娠合并精神障碍患者妊娠期及围生期处理的认识与关注,尤其注意年龄20~34岁、初次妊娠者的心理变化,及时发现异常,协同精神心理科医师积极处理,个体化选择终止妊娠方式,可取得较好的母胎结局。

Objective To investigate the clinical characteristics and therapeutic strategies for pregnant women complicated with mental disorder.Methods Clinical data of 48 pregnant women complicated with mental disorder were collected.The age of onset,gestational frequency,gestational age,method of pregnancy termination and pregnancy outcomes were analyzed.Results Forty-eight enrolled women were mainly aged from 20 to 34 years(85%),and 63%between 23 and 30 years.The proportion of primipara women was 77%,significantly higher than 23%of multipara counterparts.The percentage of women with no medical history of pregnancy was 60%,considerably higher compared with 40%of their counterparts with pregnant history.A bipolar pattern of distribution was observed in terms of gestational age.The proportion of women with early pregnancy was 35%(especially≤10 weeks)and 38%for those with late pregnancy(especially≥37 weeks).48%of mental disorders primarily occurred during the early pregnancy.Twenty-nine women terminated the pregnancy,vaginal delivery in 3 and cesarean section in 16.Among 19 newborns,the body weight was ranged from 2.5 to 4.3 kg.The 1-min Apgar score for newborns was from 8 to 10,and 10 for 5-min test.Only 1 preterm newborn was delivered.Conclusions Obstetricians should deepen the understanding of gestational and perinatal treatment for pregnant women complicated with mental disorder,especially those aged 20-34 years and with no pregnant history.Obstetricians should cooperate with the psychologists to adopt effective treatment for mental disorders,choose individualized approach of pregnancy termination and obtain favorable maternal and neonatal outcomes.