非重度妊娠期高血压、子痫前期终止妊娠时机和方式的探讨

Discussion on the Timing and Mode of Termination of Pregnancy in Non-Severe Gestational Hypertension and Preeclampsia

目的:研究非重度妊娠期高血压和子痫前期孕妇终止妊娠的时机和方式。方法:选择2018年1月至2020年12月在南京医科大学附属妇产医院住院分娩的819例非重度妊娠期高血压、子痫前期孕妇临床资料进行回顾性分析,根据分娩孕周分为4组:A组孕37~37^(+6)周、B组孕38~38^(+6)周、C组孕39~39^(+6)周、D组≥孕40周,根据分娩方式分为阴道分娩组和剖宫产组,比较不同终止妊娠时机和分娩方式的母儿结局。结果:①终止妊娠时机:随分娩孕周增加,需口服降压药控制血压者的占比、重度子痫前期(SPE)、胎儿生长受限(FGR)发生率呈下降趋势,而产后出血发生率、新生儿出生体质量呈升高趋势(P<0.05)。胎盘早剥、新生儿窒息、呼吸窘迫综合征(RDS)均发生于孕39周后。4组的引产成功率(53.85%、72.09%、70.27%、74.28%)差异无统计学意义(P>0.05)。A组的FGR发生率(35.62%)显著高于其他3组(7.50%、2.03%、0.26%,P<0.05),新生儿出生体质量(2700.00±439.12 g)显著低于其他3组(3114.17±444.71 g、3285.04±414.14 g、3452.26±388.89 g,P<0.05),需口服降压药控制血压者的占比(73.97%)、剖宫产率(61.64%)、SPE发生率(39.73%)显著高于C组(56.50%、38.21%、16.26%,P<0.05)、D组(54.47%、44.74%、10.53%,P<0.05)。D组的新生儿出生体质量显著高于其他3组(P<0.05),其产后出血发生率(15.79%)高于C组(7.32%),差异有统计学意义(P<0.05)。②终止妊娠方式:剖宫产组的需口服降压药控制血压者的占比(69.81%)、产后出血(16.71%)、SPE(30.46%)、FGR发生率(7.82%)均显著高于阴道分娩组(48.44%、6.92%、7.37%、2.68%,P<0.05),剖宫产组的新生儿窒息率(0.54%)和呼吸窘迫发生率(0.54%)与阴道分娩组(0.22%、0)比较差异无统计学意义(P>0.05)。结论:对于血压控制平稳、无并发症的非重度妊娠期高血压和子痫前期孕妇,孕37周后可积极终止妊娠,孕38周后引产成功率可能会有所提高,但分娩孕周不应超过39周,终止妊娠的方式首选阴道分娩。

Objective:To investigate the timing and mode of termination of pregnancy in pregnant women withnon-severegestationalhypertensionand preeclampsia.Methods:The clinical data of 819 pregnant women with non-severe gestational hypertension and preeclampsia who delivered in Nanjing Medical University Maternity Hospital from January 2018 to December 2020 were retrospectively analyzed.According to gestational age,they were divided into four groups:group A:37-37^(+6)weeks,Group B:38-38^(+6)weeks,Group C:39-39^(+6)weeks,and group D:≥40 weeks,and according to the delivery mode,they were divided into vaginal delivery group and cesarean delivery groupto compare the maternal and infant outcomes of different termination time and delivery mode.Results:①Timing of termination of pregnancy:With the increase of gestational age,the proportion of patients requiring oral antihypertensive drugs to control blood pressure,the incidence of severe preeclampsia(SPE)and fetal growth restriction(FGR)showed a decreasing trend,while the incidence of postpartum bleeding and newborn birth weight showed an increasing trend(P<0.05).Placental abruption,neonatal asphyxia and respiratory distress syndrome(RDS)all occurred after 39 weeks of gestation.There was no significant difference in the success rate of labor induction among the 4 groups(53.85%,72.09%,70.27%,74.28%,P>0.05).The incidence of FGR in group A(35.62%)was significantly higher than that in the other three groups(7.50%,2.03%,0.26%).The birth weight of newbornsin group A(2700.00±439.12 g)was significantly lower than that of the other three groups(3114.17±444.71 g,3285.04±414.14 g,3452.26±388.89 g).The proportion of patients requiring oral antihypertensive drugs to control blood pressure(73.97%),cesarean section rate(61.64%)and SPE incidence(39.73%)in group A were significantly higher than those in C group(56.50%,38.21%,16.26%)and D group(54.47%,44.74%,10.53%,P<0.05).The birth weight of newborns in group D was significantly higher than that in the other three groups,and the incidence of postpartum hemorrhage(15.79%)was higher than that of C group(7.32%),and the difference was statistically significant(P<0.05).②Method of termination of pregnancy:The proportion of patients requiring oral antihypertensive drugs to control blood pressure(69.81%),postpartum hemorrhage(16.71%),SPE(30.46%)and FGR(7.82%)in cesarean section group were significantly higher than those in vaginal delivery group(48.44%,6.92%,7.37%,2.68%,P<0.05).The rates of neonatal asphyxia(0.54%)and respiratory distress(0.54%)in cesarean section group were higher than those in vaginal delivery group(0.22%,0),but the differences were not statistically significant(P>0.05).Conclusions:For non-severe gestational hypertension and preeclampsia with stable blood pressure control and no complications,pregnancy can be actively terminated after 37 weeks of pregnancy,and the success rate of induced labor may be improved after 38 weeks of pregnancy,but the gestational age should not exceed 39 weeks,and vaginal delivery is the preferred way to terminate pregnancy.