子痫前期合并胎儿生长受限的妊娠结局及胎盘病理改变的研究

Pregnancy outcome and pathological changes of the placenta in preeclampsia with fetal growth restriction

目的了解子痫前期(preeclampsia,PE)合并胎儿生长受限(fetal growth restriction,FGR)孕产妇的母婴不良结局情况、胎盘病理变化及胎盘病变严重程度与母婴不良结局的相关性。方法回顾性分析2019年1月至2022年6月在广州医科大学附属第三医院产科住院并分娩的148例PE孕产妇的妊娠结局情况和胎盘病理资料,根据孕妇是否合并FGR将孕产妇分为两组:合并FGR组(44例,29.7%)为观察组,不合并FGR组(104例,70.3%)为对照组。结果(1)两组孕产妇的年龄、基础体质指数差异无统计学意义,但观察组的初产妇比例、既往有高血压和FGR病史的比例均高于对照组分别为[61.36%(27/44)vs 37.50%(39/104),11.36%(5/44)vs 2.88%(3/104),4.55%(2/44)vs 0%(0/104);P<0.05],差异有统计学意义。(2)观察组的新生儿出生体重轻于对照组[(1434.6±536.4)g vs(2288.7±976.7)g,t=5.456,P<0.001],观察组的新生儿早产和出生后入住新生儿科的发生率均高于对照组[79.5%(35/44)vs 50.0%(52/104),86.4%(38/44)vs 46.2%(48/104);P<0.001],差异有统计学意义。(3)观察组孕妇并发症的发生率均高于对照组,尤其是低蛋白血症的发生率[29.6%(13/44)vs 10.6%(11/104),χ^(2)=8.188,P=0.004],差异有统计学意义。观察组患者的肝肾功能异常和胸腹腔积液的发生率均高于对照组[11.4%(5/44)vs 3.9%(4/104),13.6%(6/44)vs 6.7%(7/104),9.1%(4/44)vs 5.8%(6/104);P>0.05]。(4)观察组孕妇的胎盘重量明显低于对照组[(345.93±101.06)g vs(436.78±125.70)g,t=4.246,P<0.001],而胎盘系数高于对照组,[(0.26±0.09)vs(0.21±0.08),t=3.181,P=0.002],差异均有统计学意义。(5)观察组的各种胎盘病变的发生率较对照组增高,尤其是蜕膜血管病和绒毛发育不全的发生率较对照组增高2倍左右,且观察组中的胎盘病变多为严重病变或弥漫性病变。结论观察组孕妇并发症的发生率整体高于对照组,其围产儿发生早产和低出生体重的情况也更严重,观察组胎盘病变情况更严重,相关胎盘病变的发生概率更高,且以弥漫性病变或严重病变为主;严重的胎盘病理改变可能与更差的围产儿不良结局相关。

Objective To analyze and compare the adverse outcomes of women and infants with Preeclampsia(PE)combined with fetal growth restriction(FGR)and the pathological changes of maternal placenta,and explore whether the adverse outcomes of women and infants with PE combined with FGR are worse.In the case of PE pregnant women with FGR,whether the maternal placenta has more serious lesions,and explore the correlation between the severity of maternal placenta lesions and adverse maternal and infant outcomes.Methods The pregnancy outcomes and maternal placenta pathology data of 148 women with PE who were hospitalized and gave birth in the Obstetrics Department of The Third Affiliated Hospital of Guangzhou Medical University from January 2019 to June 2022 were retrospectively analyzed,and 148 women were divided into two groups according to whether the pregnant women were combined with FGR:The FGR group(44 cases,29.7%)was the observation group,and the non-FGR group(104 cases,70.3%)was the control group.Results(1)There was no significant difference in age and basic body mass index between the two groups.However,the proportion of first-time mothers and previous history of hypertension or FGR in the FGR group were higher than those in the non-FGR group[61.36%(27/44)vs 37.50%(39/104),11.36%(5/44)vs 2.88%(3/104),4.55%(2/44)vs 0%(0/104)],(all P<0.05),the difference was statistically significant.(2)The birth weight of newborns in the FGR group was lower than that in the non-FGR group[(1434.6±536.4)g vs(2288.7±976.7)g,t=5.456,P<0.001],and the difference was statistically significant.The incidence of preterm birth and admission to neonatal department after birth in the FGR group was higher than that in the non-FGR group[79.5%(35/44)vs 50.0%(52/104)and 86.4%(38/44)vs 46.2%(48/104),P<0.001],the difference was statistically significant.(3)The incidence of related maternal complications in the FGR group was higher than that in the non-FGR group,especially the incidence of hypoproteinemia,which was significantly higher in the FGR group than in the non-FGR group[29.6%(13/44)vs10.6%(11/104)](χ^(2)=8.188,P=0.004).The difference was statistically significant.The incidence of liver and kidney dysfunction and thoracoabdominal effusion in patients with FGR was higher than that in patients without FGR[11.4%(5/44)vs.3.9%(4/104),13.6%(6/44)vs.6.7%(7/104)and 9.1%(4/44)vs.5.8%(6/104)].There was no significant difference(P>0.05).(4)The placental weight in the FGR group was significantly lower than that in the non-FGR group[(345.93±101.06)g vs(436.78±125.70)g,t=4.246,P<0.001],and the placental coefficient was higher than that in the non-FGR group.[(0.26±0.09)vs(0.21±0.08),t=3.181,P=0.002],the differences were statistically significant,indicating that the placental hypoplasia of pregnant women with FGR was more significant.(5)The incidence of various placental lesions in the FGR group was higher than that in the non-FGR group,especially the incidence of decidua vascular disease and villus hypoplasia was about 2 times higher than that in the non-FGR group,and the placental lesions in the FGR group were mostly severe or diffuse.Conclusions The overall incidence of maternal complications in the FGR group was higher than that in the non-FGR group,and the perinatal preterm birth and low birth weight were more serious.The placental lesions in the FGR group were more serious,that is,the incidence of related placental lesions was higher,and the lesions were mainly diffuse or severe.Severe placental pathology is likely to be associated with worse perinatal adverse outcomes.