重度子痫前期围产儿结局影响因素的分析

Analysis of factors influencing perinatal outcome in severe preeclampsia

目的分析重度子痫前期围产儿结局的影响因素。方法回顾性分析2015年6月至2018年6月西北妇女儿童医院产科重症监护病房收治的1184例重度子痫前期患者的临床资料。结果(1)1184例患者中年龄≥40岁59例(4.98%),35~39岁222例(18.75%),25~34岁822例(69.43%),≤24岁81例(6.84%)。初孕妇435例(36.74%),初产妇764例(64.53%)。(2)早发型重度子痫前期321例(27.11%),慢性高血压并发子痫前期更容易在妊娠34周前发病,与单纯重度子痫前期早发的发生率比较差异有统计学意义(χ^2=18.53,P<0.01)。早发型与晚发型重度子痫前期的妊娠期糖尿病(GDM)、胎盘早剥、HELLP综合征和死胎发生率比较差异均有统计学意义(χ^2值分别为8.74、49.82、14.05、48.45,均P<0.01)。(3)超过34周妊娠分娩863例(72.89%),其中足月妊娠419例(35.99%);剖宫分娩1090例(92.06%)。(4)自孕24周起,重度子痫前期患者所有孕周组别的新生儿平均体重均低于标准体重,但孕24~25+6周及≥40周组的新生儿体重与标准体重差别不明显,随着孕周的增加,体重差距逐渐增大,至孕33~34+6周时差距最大,此后差距逐渐缩小。(5)有34例死胎;新生儿重度窒息7例,原因分别为胎盘早剥3例,急性左心衰2例,胎儿窘迫1例,29+1周引产1例。结论重度子痫前期大多发生于初产妇中,既往有高血压的患者更容易发展为早发型重度子痫前期。重度子痫前期可期待治疗至孕34周后终止妊娠。重度子痫前期患者的新生儿体重与孕周有关,孕33周前随孕周的增加与标准体重差距增大,孕33~34+6周时差距最大,孕35周后随孕周增加体重差距减小。

Objective To analyze factors influencing perinatal outcome in severe preeclampsia.Methods The clinical data of 1184 pregnant women with severe preeclampsia who admitted to Maternity Intensive Care Unit,Department of Obstetrics of Northwest Women and Children’s Hospital from June 2015 to June 2018 were retrospectively analyzed.Results(1)Among 1184 patients,59 patients(4.98%)were≥40 years old,222(18.75%)were 35~39 years old,822(69.43%)were 25~34 years old,and 81(6.84%)were≤24 years old.435 patients were primigravidae(36.74%)and 764 patients were primiparae(64.53%).(2)There were 321 cases of early-onset severe preeclampsia,accounting for 27.11%.Chronic hypertension complicated with preeclampsia was more likely to develop before 34 weeks of gestational age,there was statistically significant difference as compared with severe preeclampsia alone(χ^2=18.53,P<0.01).In incidences of complications such as gestational diabetes mellitus(GDM),placental abruption,HELLP syndrome and stillbirth,there were significant differences between early-onset severe preeclampsia group and late-onset severe preeclampsia group(χ^2=8.74,49.82,14.05 and 48.45 respectively,all P<0.01).(3)863 patients(72.89%)delivered at over 34 weeks of gestational age including 419 cases(35.99%)of full-term pregnancy.1090 patients underwent caesarean section,accounting for 92.06%.(4)The average birth weight of the neonates born by those patients with severe preeclampsia in all gestational age subgroups since 24 weeks of gestational age were lower than standard birth weight,but the differences in birth weight in 24~25+6 weeks of gestational age group and 40 weeks or more of gestational age group were not significant compared with the standard birth weight,with increasing in gestational age,the birth weight gap gradually increased,reaching the greatest difference at 33~34+6weeks of gestational age,after that the gap was narrowed.(5)There were 34 stillbirths.And there were 7 cases of severe asphyxia of neonates due to placental abruption in 3 cases,acute left heart failure in 2 cases,fetal distress in 1 case and induced labor at 29+1 weeks of gestational age in 1 case.Conclusion Severe preeclampsia mostly occurs in the primiparae,and those patients with past history of hypertension are more likely to develop into early-onset severe preeclampsia.72.89%of severe preeclampsia cases can be expected to be treated until at more than 34 weeks of gestational age when the pregnancy can be terminated and the incidence of neonatal asphyxia is low.There was a correlation between neonatal birth weight and gestational age in the patients with severe preeclampsia.The difference in neonatal birth weight compared with the standard birth weight increases with the increase in gestational age before 33 weeks of gestational age,the difference reaches the largest at 33~34+6 weeks of gestational age,and then decreases with the increase in gestational age after 35 weeks of gestational age.