早发型和晚发型严重子痫前期合并早产198例临床分析

目的探讨早产合并早发型与晚发型严重子痫前期妊娠结局。方法选取2004年11月至2012年1月于遵义医学院第五附属(珠海)医院及广州医科大学附属第三医院重症孕产妇救治中心收治的单胎早产合并严重子痫前期的198例患者的临床资料进行回顾性分析,以孕34周为界,将早发型严重子痫前期患者作为观察组(n=121),晚发型严重子痫前期患者作为对照组(n=77),比较两组患者的临床特点及妊娠结局。结果观察组未定期产检率及疤痕子宫发生率明显高于对照组(62.0%vs 42.9%,20.7%vs 1.3%,P0.05);观察组和对照组母亲合并症/并发症总的发生率分别为65.3%和50.6%,比较差异有统计学意义(P0.05);其中,观察组心功能不全发生率较对照组显著升高(18.2%vs 7.8%,P0.05);以胎盘早剥为最常见并发症(15.7%vs 14.3%,P0.05)。两组围产儿并发症总的发生率分别为80.2%和63.6%(P0.05),观察组胎儿窘迫及新生儿重度窒息发生率明显高于对照组,差异均有统计学意义(P0.05)。两组其他方面比较差异无统计学意义(P0.05)。结论早产合并早发型与晚发型严重子痫前期相比,早发型孕妇病情重、并发症多,围产儿预后不佳。建议加强孕期保健、定期产检的宣教工作,并应根据母胎情况,适时终止妊娠。

Comparison of pregnancy outcomes of early-onset and late-onset severe preeclampsia complicated with preterm birth

Objective To investigate clinical characteristics of early-onset and late-onset severe preeclampsia and the effect on pregnancy and infant. Methods 198 cases of severe preeclampsia with preterm birth from November 2004 to January 2012 were analyzed, then they were divided into observation group （121 cases of early-onset severe preeclampsia） and control group （77 cases of late-onset severe preeclampsia） with 34 gestational weeks as boundary. Retrospective analysis was used to identify statistically significant differences in patients＇ general conditions,mode of delivery and pregnancy outcomes. Results Non-regular check rates and the incidence of uterine scar of the patients in observation group were higher than those of the control group （62.0% vs 42.9% ;20.7% vs 1.3% ,P〈0.05）. The incidence of maternal complications in observation group was significantly higher than that of the control group （65.3% vs 50.6%,P〈 0.05） ,as well as the incidence of cardiac dysfunction （18.2% vs 7.8% ,P〈0.05）. The neonatal morbidity rate was significant different between the two groups （80.2% vs 63.6%,P〈0.05）. The incidence of fetal intrauterine distress and severe neonatal asphyxia showed significant increases in observation group （14.9% vs 5.2% ,P〈0.05）.There was no statistically significant in other aspects of these two groups （P〉0.05）. Conclusions The onset of early-onset severe preeclampsia complicated with preterm birth could badly influence the prognosis of pregnant mothers and infants.It is more severe and easier to have complications than late-onset severe preeclampsia complicated with preterm birth. Strengthening the prenatal examination and prenatal care is helpful for early diagnosis and early treatment. During the expectant treatment,the conditions of maternal and fetal should be monitored and pregnancy termination should be decided at the proper time.