早发型重度子痫前期及保守治疗对早产儿预后影响因素分析

目的 探讨早发型重度子痫前期以及保守治疗对早产儿预后的影响.方法 对2001年1月至2006年5月于北京大学第三医院产科分娩、孕周<34周的早发型重度子痫前期患者76例(研究组)活产早产儿及同期孕周匹配的自发性早产患者84例(对照组)活产儿进行生长发育评估.研究组活产早产儿86例,随访71例(82.6%);对照组活产新生儿114例,随访96例(84.2%).应用丹佛智能发育筛查表(DDST)进行智能发育筛查.观察指标包括:DDST测评结果,妊娠期及围生期病历资料和临床指标.结果 研究组早产儿存活56例,存活儿智能发育正常43例(77%),可疑12例(21%),无法解释1例(2%),未发现智能发育异常或脑瘫患儿.对照组早产儿存活86例,存活儿智能发育正常65例(76%),可疑14例(16%),异常5例(6%,均为脑瘫患儿),无法解释2例(2%).早发型重度子痫前期早产儿与自发性早产早产儿比较智能发育差异无统计学意义(P>0.05).多因素分析显示,胎龄和新生儿窒息是影响早发型重度子痫前期婴儿期生存率的主要因素;出生体重是影响智能发育的保护性因素(OR0.278,95% CI 0.087～0.891).结论 在早期早产中,重度子痫前期影响小儿存活率,但不是影响小儿智能发育的因素;出生体重是早产儿智能发育的保护性因素.早发型重度子痫前期行长时间保守治疗对智能发育无不良影响;经严格选择病例,进行保守治疗延迟分娩,可以最大程度改善胎儿成熟度,改善预后.     

早发型重度子痫前期对母婴预后的影响

目的:探讨早发型重度子痫前期对妊娠结局的影响.方法:回顾性分析我院收治的218例重度子痫前期患者(其中早发型组72例,晚发型组146例,围生儿235例)的母婴结局.结果:①早发型重度子痫前期患者收缩压为168.4±20.5 mmHg,舒张压为106.8±16.5 mmHg,高于晚发组159.4±15.9 mmHg和101.5±11.2 mmHg(P均＜0.05);早发型组治疗时间为4.0±3.7天,长于晚发型组(1.3±2.4)天(P＜0.01);早发型组分娩孕周为33.6±2.6周,早于晚发型组38.4±1.8周(P＜0.01);②早发型组母亲低蛋白血症的发生率55.6%,高于晚发型组34.3%(P＜0.01);早发型组母亲心功能不全、子痫、HELLP综合征、胎盘早剥、视网膜剥离、肾功能损害等严重并发症总发生率为26.4%,高于晚发型组14.3%(p＜0.05);③早发型纽围生儿体重低于晚发型组(P＜0.01),且早发型组围生儿中早产、FGR、新生儿窒息、转入NICU及围生儿死亡率均分别高于晚发型组(P均＜0.01);④早发型组中发病孕周越早,围生儿体重越低(P＜0.01),入住NICU率越高(P＜0.01),围生儿死亡率、FGR及早产发生率逐渐增加.结论:早发型重度子痫前期孕妇病情严重,围生儿预后不佳,且发病越早,围生儿预后越差.严格选择病例行短期的期待治疗是安全有效的.     

早发型重度子痫前期101例临床分析

目的:探讨早发型重度子痫前期的临床特征及对妊娠结局的影响.方法:回顾性分析我院收治的289例重度子痫前期病例(其中早发型组101例,晚发型组188例,围生儿301例)的母婴结局.结果:①早发型组的发病时平均血压、发病孕周、分娩孕周及严重并发症发生率与晚发型组比较,差异有统计学意义(P＜0.05);两组分娩方式比较,差异无统计学意义(P＞0.05);且早发型组胎儿脐血流比值(S/D)、胎儿生长受限(FGR)、早产、胎儿窘迫、新生儿窒息、围生儿死亡的发生率高于晚发型组,差异有统计学意义(P＜0.05);②早发型重度子痫前期按发病孕周分为A组(＜28周)、B组(28 ～31+6周)、C组(32 ～ 33+6周),3组围生儿结局比较,A组病例中胎儿脐动脉S/D≥3、FGR及新生儿窒息的发生率均高于B组及C组(P＜0.05);而A组及B组围生儿死亡率高于C组,差异有统计学意义(P＜0.05);③早发型重度子痫前期病例中脐动脉S/D≥3的病例,FGR、胎儿窘迫、新生儿窒息及围生儿死亡的发生率均高于S/D ＜3的病例(P＜0.05);两者间早产的发生率差异无统计学意义(P＞0.05).结论:早发型重度子痫前期孕妇发病孕周越早,FGR、新生儿窒息、胎儿窘迫及围生儿死亡发生率越高,围生儿结局不佳.基层医院应加强孕期保健,定期行产前检查.     

早发型重度子痫前期与脑卒中

早发型重度子痫前期相关的脑卒中的发病机制有血管反应及遗传因素导致细胞内皮功能障碍、自身免疫增强、脑血管自动调节功能破坏及高血压.脑卒中起病及发病后的临床表现与重度子痫前期及子痫的临床表现有重叠.MRI是妊娠期的首选头部影像学检查,CT及MRI基本可以明确颅内病变性质.其治疗应个体化,提倡定期的孕期检查.     

早发型重度子痫前期的临床特点及围生期结局

目的探讨早发型重度子痫前期患者的临床特点及对母婴预后的影响。方法选取2001年1月～2004年12月天津市中心妇产科医院住院的794例重度子痫前期患者作为研究对象，将病例分为早发型重度子痫前期（妊娠〈32周，312例）和晚发型重度子痫前期（妊娠≥32周，482例）。回顾性分析比较两组患者的临床资料。结果早发型重度子痫前期组临床严重并发症如子痫、心衰、肺水肿、腹水、胸腔积液、胎盘早剥、产后出血的发生率均明显高于晚发型重度子痫前期组，差异有显著性（P〈0．01）；早发型重度子痫前期组围产儿死亡率及新生儿Apgar评分≤7分的发生率显著高于晚发型重度子痫前期组（P〈0．01）。结论早发型重度子痫前期病情严重，围产儿预后不良，应根据母婴情况，严格选择病例进行期待疗法，同时密切监测母婴病情变化。     

早发型重度子痫前期早期预警因素研究

目的:探讨早发重度子痫前期孕20周前的预警因素,提高早发重度子痫前期诊断前的识别能力。方法:回顾分析2014年1月至2020年12月于天津市第五中心医院(北京大学滨海医院)分娩的50例早发重度子痫前期单胎孕妇的临床资料,以同期分娩的150例正常单胎孕妇作为对照组。采用单因素分析及多因素回归方法分析两组孕前及孕20周的体质量指数(BMI)、收缩压、舒张压,早孕期化验指标包括白细胞计数、红细胞计数、血红蛋白、血小板、总蛋白、白蛋白、总胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、尿素氮、肌酐、尿酸等临床指标变化。探讨早发重度子痫前期孕20周前产前检查中的可能预警因素。结果:单因素分析结果显示,PE组早孕期及孕14～19⁺⁶周收缩压、舒张压及平均动脉压,孕前及孕20周BMI,不良孕产史和高血压家族史,早孕期丙氨酸转氨酶、天冬氨酸转氨酶、尿酸均高于对照组(P<0.05)。logistic回归分析结果显示,早孕期收缩压、孕14～19⁺⁶周平均动脉压,不良孕产史、高血压家族史,早孕期丙氨酸转氨酶上升是早发重度子痫前期发病的独立危险因素。结论:早孕期血压、丙...     

早发型重度子痫前期妊娠结局分析

目的:探讨早发型重度子痫前期的临床特点及围生结局。方法:回顾性分析2006年6月至2009年6月四川大学华西第二医院收治的重度子痫前期患者413例,以发病孕周34周为界限,分为早发型重度子痫前期组156例(早发型组)及晚发型重度子痫前期组257例(晚发型组)。比较两组一般情况、并发症、分娩方式及围生儿结局等指标。结果:早发型组患者在终止妊娠孕周、延长孕周时间、住院时间、入院时血压、24小时尿蛋白、并发症发生率及围生儿结局等方面与晚发型组比较,差异均有高度统计学意义(P<0.01)。结论:早发型重度子痫前期患者病情严重,围生儿预后不佳,应根据母胎情况,适时剖宫产终止妊娠。     

早发型重度子痫前期期待治疗

早发型重度子痫前期发病率约为0.3%,部分妊娠24~27周的孕妇可以在密切监护下进行期待治疗,指征如下：（1）一过性实验室检查异常。（2）单纯的尿蛋白异常。（3）单纯的胎儿生长受限。（4）单纯的血压异常。     

早发型重度子痫前期的研究进展

早发型重度子痫前期由于其发病早,病情重;较多的并发症;多器官功能同时受损;距离足月较远,使临床处理较为棘手。近年来众多学者提出了期待治疗方法。期待治疗是在严格选择病例的前提下,密切监测母婴病情变化,兼顾母儿利益的同时尽量延长孕周,并适时终止妊娠。现将早发型重度子痫前期发病机制、临床特点、期待治疗对象的选择及治疗方法做一综述。     

早发型重度子痫前期期待治疗探讨

妊娠期高血压疾病是妊娠期常见的特发性疾病,重度子痫前期是孕产妇及围产儿死亡的重要原因。有学者将在32孕周前发病的重度子痫前期称为早发型,然而更多的学者将于34孕周前发病的重度子痫前期称为早发型[1]。早发型重度子痫前期临床上处理非常棘手。现对我院1997年8月至2006年10月收治的早发型重度子痫前期患者的临床资料作一回顾分析,重点探讨不同孕周的早发型重度子痫前期期待治疗对母儿结局的影响。1资料与方法1.1一般资料1997年8月至2006年10月在我院妇产科分娩总共18 829例,其中重度子痫前期175例,发病率0.93%。诊断标准参照高等院校统…     

早发型重度子痫前期期待治疗妊娠结局的多因素分析

目的探讨早发型重度子痫前期期待治疗中母儿不良妊娠结局的独立危险因素。方法对57例经期待治疗的早发型重度子痫前期孕妇的临床资料进行总结分析,按照有无孕妇及新生儿严重并发症（包括新生儿死亡）的发生分别分为孕妇不良妊娠结局组与对照组和新生儿不良结局组与对照组,分别比较两组患者的一般临床情况及各项检验指标。采用多因素Logistic回归分析母儿不良妊娠结局的危险因素。结果57例早发型重度子痫前期期待治疗中,16例孕妇出现严重并发症,发生率为16/57（28.1%）,无孕产妇死亡。胎死宫内3例,12例新生儿出现明显并发症,其中6例新生儿死亡,围产儿死亡率为9/57（15.8‰）。经多因素回归分析,发病孕周（以30周为界）及血小板减少是孕妇严重并发症发生的独立危险因素,比数比分别为5.2（95%CI 1.1-24.0,P=0.04）和4.6（95%CI 1.2-17.6,P=0.03）。分娩孕周（以32周为界）是新生儿病率及死亡率的独立危险因素,比数比为6.0（95%CI 1.5-24.9,P=0.01）。结论早发型重度子痫前期期待治疗中需严密监护。发病孕周不足30周及血小板降低者孕妇严重并发症的发生显著增加,而分娩孕周超过32周,新生儿结局将显著改善,因此需权衡利弊,选择恰当时机终止妊娠。     

Management of late preterm and early-term pregnancies complicated by mild gestational hypertension/pre-eclampsia

Gestational hypertension/pre-eclampsia is the most frequent obstetrical complication, complicating 26%-29% of all gestations in nulliparous women. In general, the diagnosis of mild gestational hypertension/pre-eclampsia is made at 38 weeks or more in approximately 80% of cases. For many years, the optimal timing of delivery for patients with mild gestational hypertension/pre-eclampsia at 37-0/7 to 39-6/7 weeks was unclear. Recently, investigators of the HYPITAT (Pregnancy-induced hypertension and pre-eclampsia after 36 weeks: induction of labor versus expectant monitoring: A comparison of maternal and neonatal outcome, maternal quality of life and costs) randomized trial evaluated maternal and neonatal complications in patients at 36-40 weeks' gestation who were randomized to either induction of labor or expectant monitoring. The results of this trial revealed that induction of labor at or after 37-0 weeks was associated with lower rate of maternal complications without increased rates of either cesarean delivery or neonatal complications. In contrast, the optimum management for those with mild hypertension/pre-eclampsia with stable maternal and fetal conditions at 34-0/7 to 36-6/7 weeks remains uncertain. Therefore, there is urgent need for research to evaluate the reasons for late preterm birth in such women as well as for a randomized trial to evaluate the optimal timing for delivery in such patients.     

One-year infant outcome in women with early-onset hypertensive disorders of pregnancy

Objectives  To evaluate the role of plasma volume expansion on 1-year infant outcome after severe hypertensive disorders of pregnancy and to determine prognostic factors for adverse neurodevelopmental infant outcome.
Design  Randomised controlled trial, observational prognostic study.
Setting  Two university hospitals in Amsterdam, The Netherlands.
Population  One hundred and seventy-two infants alive of 216 mothers with severe hypertensive disorders of pregnancy who were randomised for a temporising management strategy with or without plasma volume expansion.
Methods  At 1 year of corrected age, a neurological examination according to Bayley (mental development index [MDI] and psychomotor development index [PDI]) and Touwen was performed.
Main outcome measures  Adverse neurodevelopmental infant outcome was defined as a MDI/PDI score below 70 and/or an abnormal Touwen. Risk factors for adverse neurodevelopmental outcome were explored by univariate and multivariate analyses.
Results  Adverse neurodevelopmental infant outcome was observed in 31 infants (18%). There were no differences between the randomisation groups. In multivariate analysis, an association with abnormal umbilical artery/middle cerebral artery Doppler ratio higher than the median, major neonatal morbidity, higher education of the parents, multiparity and Caucasian ethnicity was observed.
Conclusion  Nearly 70% of the infants were alive at 1 year without adverse neurodevelopmental outcome. Maternal plasma volume expansion during pregnancy has no effect on 1-year infant outcome. The prediction of adverse outcome at 1 year by perinatal parameters is limited.     

Prenatal prediction of neonatal survival at the borderline viability

Objective.?Prenatal prediction of neonatal survival and survival without short term major morbidity (STMM) in babies born at the borderline of viability.

Methods.?Obstetric and neonatal records of 471 babies born from 22 0/7 to 25 6/7 weeks between the years 2000 to 2007 were reviewed. A total of 179 live-born nonanomaluos singleton infants with birth-weights of 300–1397?g, who underwent ultrasonographic examination?<7days before delivery, qualified for the study. Ultrasound biometry, use of antenatal steroids, fetal gender, race, gestational age, estimated fetal weight, and maternal medical and obstetric characteristics were evaluated. Univariate analyses, logistic regression, and bootstrapping using 10,000 resamplings were performed to derive prediction formulas that projected neonatal outcomes. From these, quantitative patient-specific prenatal estimates of neonatal survival and survival without STMM were calculated.

Results.?On the basis of the use of prenatally available parameters, neonatal survival was predicted with a sensitivity of 85.5% and specificity of 70.6%. Area under ROC curve (95%CI)?=?0.835 (0.777–0.894). Corresponding values for survival without STMM were 94.7% and 34%. Area under ROC curve (95%CI) 0.738 (0.640–0.836). Among positive predictors of survival it is worth mentioning: intact membranes, femur length?≥39.1?mm and estimation of fetal weight?>?493g.

Conclusion.?Prenatal prediction of neonatal survival and STMM was achieved. This approach has the potential improve counseling and obstetric decision making at the borderline of viability.     

Urinary protein excretion and expectant management of early onset, severe pre-eclampsia.

OBJECTIVE: To evaluate the importance of proteinuria in the expectant management of early onset, severe pre-eclampsia. METHODS: In this prospective series of 340 women, 24-h urine collections were performed and monitored twice weekly in a high-care ward. RESULTS: Seventy-four women with at least two 24-h urine collections were grouped into women with a proteinuria increase of > or =2 g (n=29) and with women whose proteinuria decreased, or increased by <2 g (n=45). Major maternal complications, prolongation of gestation, and perinatal outcomes were comparable. Fifty-six (75%) women experienced an increase in proteinuria. When patients with heavy proteinuria (n=83) were compared to those with moderate proteinuria (n=257), maternal and perinatal outcomes were comparable. More days were gained before delivery in the heavy proteinuria group than in the moderate (12 vs. 9; P<0.001). CONCLUSION: Most patients experienced increased proteinuria. Neither the rate of increase nor the amount of proteinuria affected maternal and perinatal outcomes.     

重度子痫前期孕妇及胎儿左室重构与ET浓度的研究

目的:研究重度子痫前期孕妇及胎儿左室重构与内皮素(endothelin,ET)的相关性。方法:53例重度子痫前期孕妇分娩前测定外周血ET水平,用二维多普勒彩超检测孕妇和胎儿左心室舒张末期室间隔厚度(IVST)、左室后壁厚度(PWT)、室壁相对厚度(RWT)及孕妇左心室质量指数(LVMI)等指标;选取与病例组孕妇同期的健康孕妇53例为对照组,测量其心脏结构指标及ET水平,比较两组间孕产妇及胎儿左室重构与内皮素间有无相关性,同时比较实验组与对照组间有无差别。结果:(1)病例组孕妇及胎儿的IVST、PWT及孕妇的LVMI和RWT均高于对照组;(2)病例组孕妇及胎儿的ET水平高于对照组。结论:(1)重度子痫前期孕妇及胎儿有左室重构;(2)血浆ET升高是表明重度子痫前期严重程度的指标之一。     

Death or survival with major morbidity in VLBW infants born at Brazilian neonatal research network centers

Objective: To analyze unfavorable outcomes at hospital discharge of preterm infants born at Brazilian public university centers.

Methods: Prospective cohort of 2646 inborn infants with gestational age 23–33 weeks and birth weight 400–1499?g, without malformations, born at 20 centers in 2012–2013. Unfavorable outcome was defined as in-hospital death or survival at hospital discharge with ≥1 major morbidities: bronchopulmonary dysplasia (BPD) at 36 corrected weeks, intraventricular hemorrhage (IVH) grades 3–4, periventricular leukomalacia (PVL) or surgically treated retinopathy of prematurity (ROP).

Results: Among 2646 infants, 1390 (53%) either died or survived with major morbidities: 793 (30%) died; 497 (19%) had BPD; 358 (13%) had IVH 3–4 or PVL; and 84 (3%) had ROP. Logistic regression adjusted by center showed association of unfavorable outcome with: antenatal steroids (OR 0.70; 95%CI 0.55–0.88), C-section (0.72; 0.58–0.90), gestational age <30 (4.00; 3.16–5.07), being male (1.44; 1.19–1.75), small for gestational age (2.19; 1.72–2.78), 5th-min Apgar <7 (3.89; 2.88–5.26), temperature at NICU admission <36.0?°C (1.42; 1.15–1.76), respiratory distress syndrome (3.87; 2.99–5.01), proven late sepsis (1.33; 1.05–1.69), necrotizing enterocolitis (3.10; 2.09–4.60) and patent ductus arteriosus (1.69; 1.37–2.09).

Conclusions: More than half of the VLBW infants born at public university level 3 Brazilian hospitals either die or survive with major morbidities.     

Polymorphisms of the angiotensin converting enzyme gene in early-onset and late-onset pre-eclampsia

Objective.?The aim of this study was to investigate differences in maternal and infant ACE genotypes in early-onset and later-onset pre-eclampsia/toxemia (PET).

Methods.?We conducted a case–control study of 22 cases of early-onset pre-eclampsia (before 34 weeks gestation), 38 cases of later-onset pre-eclampsia (after 34 weeks gestation), and 108 healthy controls delivered at term (38–40 weeks gestation) within a stable Caucasian population. Maternal venous blood and cord bloods were obtained for serum angiotensin converting enzyme (ACE) activity, ACE genotype, and acid–base status.

Results.?Mothers who developed early-onset PET were more likely to be homozygous for the deletion allele of the ACE genotype (DD) than mothers with late-onset PET or uncomplicated pregnancies (12/22 (55%) vs. 7/38 (18%) vs. 22/105 (21%), respectively; OR 2.96 [95% confidence intervals (CI) 1.37–6.31]. Infants of mothers with early-onset PET were more likely to be homozygous for the DD genotype than infants of mothers with late-onset PET or controls (7/19 (37%) vs. 9/36 (25%) vs. 11/78 (14%); OR 2.51 (95% CI 1.12–5.61). There were no differences in maternal or infant ACE activities in relation to onset of pre-eclampsia.

Conclusions.?Our findings suggest an association between the DD genotype of the ACE gene and early-onset but not later-onset pre-eclampsia which may give a partial explanation for the higher recurrence risk with early-onset pre-eclampsia.