妊娠期高血压疾病剖宫产孕妇再次妊娠发生早发型子痫前期的临床分析

Clinical characteristics of pregnant women complicated with early onset preeclampsia with prior cesarean section due to hypertensive disorders of pregnancy

目的分析既往因妊娠期高血压疾病剖宫产孕妇再次妊娠发生早发型子痫前期的危险因素及母儿围产期结局。方法收集2017年1月至12月来自11家三级医院既往因妊娠期高血压疾病剖宫产后再次妊娠的478例孕妇的临床资料,采用Logistic多因素回归分析方法,分析既往高血压类型和再次妊娠的临床特征与早发型子痫前期的相关性,以及早发型子痫前期对母儿围产期结局的影响。结果转诊和高血压病史是既往因妊娠期高血压疾病而剖宫产的孕妇再次妊娠发生早发型子痫前期(转诊a OR=6.085,95%CI=2.209~16.759,高血压病史a OR=28.860,95%CI=4.309~193.277)、妊娠期高血压(转诊a OR=2.912,95%CI=1.524~5.567,高血压病史a OR=14.094,95%CI=3.881~51.190)及晚发型子痫前期(转诊a OR=2.602,95%CI=1.325~5.109,高血压病史a OR=17.755,95%CI=4.728~66.671)的危险因素。与血压正常、妊娠期高血压、晚发型子痫前期孕妇相比,早发型子痫前期孕妇住院时间长,转入新生儿重症监护率高(76.5%vs 10.4%,X^(2)=133.40;76.5%vs 31.1%,X^(2)=26.69;76.5%vs 21.4%,X^(2)=41.84,P值均<0.05)。结论早发型子痫前期对孕妇及新生儿的影响较大,对高危人群的早期识别和防治具有重要意义。

Objective To analyze the risk factors and perinatal outcomes of early onset preeclampsia in pregnant women with previous cesarean section due to hypertensive disorders.Material and Methods 478 pregnant women with prior cesarean section history due to hypertensive disorders of pregnancy from 11 tertiary hospitals between January and December 2017 were recruited.We used multivariate Logistic regression to analyze the relationship between the types of prior hypertensive disorders and the clinical features of pregnancy and early onset preeclampsia.We also analyzed the effects of early onset preeclampsia on maternal and perinatal outcomes.Results Referral and history of hypertension were the risk factors for early onset preeclampsia(referral a OR=6.085,95%CI=2.209-16.759,history of hypertension a OR=28.860,95%CI=4.309-193.277),gestational hypertension(referral a OR=2.912,95%CI=1.524-5.567,history of hypertension a OR=14.094,95%CI=3.881-51.190)and late onset preeclampsia(referral a OR=2.602,95%CI=1.325-5.109,history of hypertension a OR=17.755,95%CI=4.728-66.671).Comparing with normal blood pressure,gestational hypertension or late onset preeclampsia,women complicated with early onset preeclampsia had a longer hospital stay,lower neonatal weight,Apgar score,and higher NICU admission rate(76.5%vs 10.4%,X^(2)=133.40,76.5%vs 31.1%,X^(2)=26.69,76.5%vs 21.4%,X^(2)=41.84,P<0.05).Conclusions Early onset preeclampsia has a great impact on pregnant women and newborns.Earlier identification and prevention for women with high risks of early onset preeclampsia are important.