先兆子癎致医源性早产122例分析

122 Cases Analyses of Preeclampsia Caused to Preterm Labor

目的 探讨先兆子发生在妊娠小于 3 7周的母儿结局。 方法 回顾性分析我院19 93年 1月～ 2 0 0 2年 12月间收治的 12 2例 (多胎妊娠除外 )孕周小于 3 7周的先兆子孕妇的诊断、处理母儿结局。按终止妊娠的孕周将 12 2例孕妇分为三组 ,1组为妊娠 2 8周～ 3 1+ 6 周 (2 8例 ) ;2组为妊娠 3 2～ 3 3 + 6 周 (2 6例 ) ;3组为妊娠 3 4～ 3 6+ 6 周 (68例 ) ,比较其发病情况、疾病进展、母儿并发症及结局。采用SAS软件进行计算机统计分析。 结果 起病早的妊娠高血压综合征 ,在短期内就可发展为先兆子 (14 0 3d ,16 85d ,2 2 2 2d ,P <0 .0 5)。不同孕周的先兆子孕妇经控制病情及适时终止妊娠 ,各组孕妇的子 (3 57% ,3 85% ,4 41% )、胎盘早剥 (2 8 57% ,11 54% ,10 2 9% )、HELLP综合征 (14 2 9% ,3 85% ,11 76% )、肝肾损害及胎儿宫内窘迫 (17 86% ,3 0 76% ,3 9 71% )、FGR(2 5 0 0 % ,2 6 92 % ,2 7 94% )等严重并发症的发生无统计学意义 (P >0 .0 5) ,孕妇预后良好。在不增加孕妇并发症的同时延长孕周 ,使 60 .64%的孕妇接受了促胎肺成熟的治疗。三组不同孕周的围产儿的SGA、颅内出血、呼吸暂停发生的差异无显著性 (P >0 .0 5) ;尽管RDS(2 2 73 % ,8 0 0 % ,4 48% )及重度窒息 (3

ObjectiveTo investigate the outcomes of mother a nd baby smaller than 37 gestational age caused by preeclampsia. Method sThe data for 122 preterm birth that was single pregnancy with preecla mpsia in our hospital from January 1993 to December 2002 were collected. The pri nciple of diagnosis and treatment, the outcomes were analyzed retrospectively. T he 122 pregnant women were divided into 3 groups according to their gestational age, more than 28 weeks and smaller than 31 +6 weeks was the first group (28 cases), more than 32 weeks and smaller than 33 +6 weeks was the second grou p (26 cases), more than 34 weeks and smaller than 36 +6 weeks was the thir d group (68 cases). The data were statisted with SAS software.Results The earlier the pregnancy-induced hypertension happened, the earlier the preeclampsia occured, the mean time was 14 03 d, 16 85 d,22 22 d, respect ively, (P<0.05). The pregnancy of different gestational age were terminate d in time after the control of the disease The rate of complication such as ecla mpsia (3 57%,3 85%,4 41%), placental abruption (28 57%,11 54%,10 29%), HEL LP syndrome (14 29%,3 85%,11 76%), fetal distress (17 86%,30 76%,39 71%), and FGR (25 00%,26 92%, 27 94%) of three groups were similar, (P>0.05), the outcomes of mothers were good. Increasing the gestational age under the cond ition that the occurrene of comptications was not increased, 60 64% pregnant wo men accepted the treatment of improving the maturity of fetal lung. There were n o differences among the three groups at the morbidity of perinatal SGA, intracra nial hemorrhage (P<0.05). Although the morbidity of RDS (22 73%,8 00%,4 4 8%) and severe asphyxia (36 36%,4 00%,8.96%) of three groups were different ( P<0.05),the perinatal death rate (35 71%,23 07%,16 18%) were similar (P > 0.05) .ConclusionWe could improve the outcomes of pret erm birth caused by preeclampsia by enhancing the perinatal care, treating and t erminating pregnancy activey Increasing the gestational age, improving the matur ity of fetal lung would decrease the morbidity of severe RDS and improve the pe rinatal outcome effectively.