妊娠期高血压疾病发病规律及高危因素分析

目的:探讨妊娠期高血压疾病(HDCP)严重并发症相关高危因素。方法:对住院分娩诊断为HDCP孕妇年龄、孕、产次、双(多)胎、地区、是否系统产检、高血压病史和妊娠期高血压病史及家族史、HDCP及其严重并发症发病情况、围生儿情况进行调查分析HDCP发病的一般规律、城市/乡村发病的差别以及导致孕产妇及围生儿严重并发症的高危因素。结果:住院孕妇总数为24 154例,其中HDCP患者921例,发生率为3.81%。妊娠高血压、子痫前期、子痫、慢性高血压并子痫前期、妊娠合并慢性高血压分别占HDCP的29.97%、64.60%、2.39%、2.39%、0.65%,产后出血及胎儿宫内生长受限分别占HDCP的50.00%、44.00%。HDCP患者中城市505例,农村416例,合并严重并发症城市10例,农村36例;围产儿不良结局(包括FGR、死胎、新生儿死亡、流产、新生儿窒息等)城市82例,农村129例,将孕妇年龄分为17～20、21～25、26～30、31～35、36～40和≥41岁年龄段,其HDCP发生率分别为6.73%、28.23%、28.66%、21.82%、11.62%、2.93%;在17～20岁年龄段围产儿不良结局发生率比其他年龄段显著增高(P<0.05),孕妇合并严重并发症在各年龄段间差异无统计学意义(P>0.05)。Logistic逐步回归分析低龄、双胎(多胎)、农村地区、文化程度及无系统产检均为HDCP孕妇严重并发症及围生儿不良结局的高危因素。结论:产后出血、早产及胎儿宫内生长受限仍是江西省HDCP孕妇和围生儿最主要的并发症。年龄、农村人口、文化程度≤初中、无系统产检是HDCP孕妇严重并发症及围生儿不良结局的高危因素。

Analysis on occurrence regularity of hypertensive disorder complicating pregnancy and high risk factors

Objective:To explore the related high risk factors of hypertensive disorder complicating pregnancy(HDCP).Methods:The data of pregnant women who were diagnosed as h ypertensive disorder complicating pregnancy(HDCP) were Collected and investigated,then they gave birth to their babies in the hospital from July 1,2008 to June 30,2010.The data collected included age,times of pregnancy,double(multiple) pregnancy,the urban-rural structure,systematicness of prenatal examination,histories of hypertension,hypertensive disorder complicating pregnancy(HDCP),and family medical history,situations of HDCP,serious complications of HDCP,and perinatal situation.The general occurrence regularity of HDCP,the incidence differences between cities and countries and the high risk factors of serious complications of maternal and perinatal child were analyzed.Results:From July 1,2008 to June 30,2010,the total number of hospitalized pregnant women in the hospital was 24 154.Ninety-two patients were found with HDCP.The incidence rate was 3.81%,the constituent ratios of preeclampsia,eclampsia,chronic hypertension merged preeclampsia,pregnancy combined with chronic hypertension among HDCP patients were 29.97%,64.60%,2.39%,2.39%,and 0.65%,respectively.And the incidence rates of postpartum hemorrhage and fetal growth restriction were 50% and 44%,respectively.Among these 921 HDCP women,there were 505 urban cases and 416 rural cases.Ten HDCP women with serious complications were from cities,the rate was 1.09%.Thirty-six cases were from rual areas,the rate was 3.91%.Eighty-two cases were found with perinatal adverse outcomes,including fetal growth restriction,stillbirth,neonatal death,abortion,neonatal asphyxia,accounting for 8.90%,129 cases were from rural areas,accounting for 14.00%;puting maternal age into six fractions as below: 17-20,21-25,26-30,31-35,36-40,and >40 years,the HDCP incidence rates were 6.73%,28.23%,28.66%,21.82%,11.62%,and 2.93%,respectively.Among these cases,the incidence rates of perinatal adverse outcomes in 17-20 year-old women significantly increased compared with other age groups(P<0.05).But there were no statistically significant difference in the incidence rate of pregnancy combined with severe complications among the six age groups(P>0.05).Logistic regression analysis showed that the high risk factors of severe maternal complications and perinatal child adverse outcomes of HDCP pregnant women included younger twins(multiple births),living in rural areas,education level,and systematicnessless of prenatal examination.Conclusion:Postpartum hemorrhage,premature birth,and fetal growth restriction are still the most common complications of perinatqal infants and HDCP pregnant women in the city.Age,rural population,education level≤junior high school,and systematicnessless of prenatal examination are high risk factors of serious complications and adverse outcomes of HDCP pregnant women and perinatal children.So the propaganda work of prenatal care should be enhanced,and delayed marriage and childbearing should be advocated.