不同特征子痫前期孕妇母儿并发症比较

Comparison of maternal and fetal complications in pregnant women with different characteristics of preeclampsia

目的探讨轻、重度组子痫前期患者,单、双胎组妊娠并发子痫前期患者,辅助生殖技术(ART)与非ART并发子痫前期患者妊娠结局的差异。方法查询2014—2019年在厦门大学附属妇女儿童医院就诊的1849例子痫前期孕妇的病案信息,评价不良结局与重度子痫前期、双胎妊娠并发子痫前期及ART并发子痫前期的相关性。结果2014—2019年,在住院分娩治疗患者中,子痫前期患者1849例,其中重度子痫前期922例,轻度子痫前期702例。不同程度子痫前期患者年龄、孕次及平均孕周比较,差异均有统计学意义(均P<0.05)。重度组甲状腺功能减退(包含亚临床型甲状腺功能减退)、肾功能不全、肝功能损害、肺部并发症、胎盘早剥及Hellp综合征等发生率高于轻度组,重度组胎膜早破发生率低于轻度组,重度组胎儿窘迫、胎儿生长受限及胎儿窒息发生率高于轻度组。双胎子痫前期患者265例,单胎子痫前期患者1517例。单、双胎组患者产次、IVF率及平均孕周比较,差异均有统计学意义(均P<0.05)。双胎组患者甲状腺功能亢进(包含亚临床甲状腺功能亢进)、贫血及妊娠期肝内胆汁淤积症发生率高于单胎组,胎膜早破、B链感染发生率低于单胎组。双胎组胎儿窘迫发生率低于单胎组。通过ART受孕的子痫前期患者211例,非ART受孕的子痫前期患者1575例。ART组和非ART组年龄、孕次、平均孕周及双胎率比较,差异均有统计学意义(均P<0.05)。ART组贫血发生率高于非ART组。ART组胎儿窘迫、胎儿生长受限发生率均低于非ART组。结论重度组母儿并发症风险普遍较高,双胎组甲状腺功能亢进、贫血及妊娠期肝内胆汁淤积症发生风险增高,ART未明显增加母儿并发症风险。

Objective To explore the differences in pregnancy outcomes between mild and severe preeclampsia patients,single and twin pregnancy patients with preeclampsia,assisted reproductive technology(ART)and non ART patients with preeclampsia.Methods 1849 cases of pregnant women with preeclampsia attending Xiamen University Women's and Children's Hospital from 2014 to 2019 were inquired.The correlation between adverse outcomes and severe preeclampsia,twin pregnancy with preeclampsia,ART with preeclampsia was evaluated.Results From 2014 to 2019,1849 patients with preeclampsia were hospitalized for delivery treatment,including 922 cases of severe preeclampsia and 702 cases of mild preeclampsia.There were statistically significant differences in age,gestational frequency,and average gestational week among patients with different degrees of preeclampsia(all P<0.05).The incidence of hypothyroidism(including subclinical hypothyroidism),renal insufficiency,liver function damage,pulmonary complications,placental abruption,and Hellp syndrome in the severe preeclampsia group is higher than that in the mild group.The incidence of premature rupture of membranes in the severe preeclampsia group is lower than that in the mild group,and the incidence of fetal distress,fetal growth restriction,and fetal asphyxia in the severe group is higher than that in the mild group.There were 265 cases of twin preeclampsia and 1517 cases of singleton preeclampsia.There were statistically significant differences in parity,IVF rate,and average gestational age between the single and twin group patients(all P<0.05).The incidence of hyperthyroidism(including subclinical hyperthyroidism),anemia,and intrahepatic cholestasis during pregnancy in the twin group was higher than that in the singleton group,while the incidence of premature rupture of membranes and B-chain infection was lower than that in the singleton group.The incidence of fetal distress in the twin group is lower than that in the singleton group.211 preeclampsia patients who were conceived through ART,and 1575 were not.There were statistically significant differences in age,gestational frequency,average gestational week,and twin birth rate between the ART group and the non ART group(all P<0.05).The incidence of anemia in the ART group is higher than that in the non ART group.While the incidence of fetal distress and fetal growth restriction in the ART group was lower.Conclusion The risk of maternal and fetal complications was generally higher in severe group.Twin group have an increased risk of hyperthyroidism,anemia,and gestational cholestasis syndrome.ART did not significantly increase the risk of maternal and neonatal complications in preeclampsia.