重度子痫前期早产与自发性早产临床结果的对比分析

目的通过对不同类型重度子痫前期早产和自发早产临床结果的对比分析,探讨重度子痫前期早产的母儿结局。方法回顾性分析2001年1月至2005年12月我院收治的119例孕周<36周因重度子痫前期及其并发症而终止妊娠的单胎早产活产孕妇(研究组)的诊断,处理和母儿结局,并与243例单胎自发性早产孕妇(对照组)进行孕产妇及围生儿结局对比分析。结果研究组的剖宫产率为95.8%(114/119例),明显高于对照组的21.0%(P<0.01)。研究组和对照组的孕28～31~( 6)周的规律产前检查率分别为42.9%和52.8%,均明显低于孕32～36周的81.3%和88.9%(P值均<0.05)。研究组和对照组的新生儿死亡均发生在孕28～31~( 6)周,病死率分别为4.2%和2.5%,两组间差异无统计学意义(P>0.05)。研究组的新生儿平均出生体质量[(1921.5±610.5)g]明显低于对照组[(2449.5±530.7)g,P<0.05],小于孕龄儿(43.7%)、新生儿呼吸窘迫综合征(5.9%)、重度窒息发生率(16.8%)、新生儿监护室住院天数[(20.1±7.1)d]均明显高于对照组[分别为4.1%、0.8%、2.1%、(8.8±3.8)d,P值均<0.05]。结论良好的产前监护对降低早期早产的发生有重要的临床意义;早发型重度子痫前期严重影响胎儿生长;不论重度子痫前期早期早产还是自发性早期早产,新生儿死亡率均较高。

Comparison of clinical outcome of severe preeclampsia preterm birth and spontaneous preterm birth

Objective To appraise the relevant factors of maternal and neonatal outcomes in severe preeclampsia (S-PE)preterm birth by comparation with spontaneous preterm birth.Methods A comparative study was conducted among 119 cases of S-PE preterm birth and 243 cases of spontaneous preterm birth from 28 to 36 weeks of gestation,Results Most patients in S-PE underwent cesarean delivery.In early preterm birth whose gestational weeks were less than thirty-two weeks,the cases with antenatal care were much lower than the cases whose gestational weeks exceeding thirty-two weeks. The neonatal mortality rates were all in the cases whose gestational weeks were less than thirty-two weeks,no difference was seen between these groups.The average birth weight,rates of SGA,NRDS,severe neonatal asphyxia and the duration of NICU hospitalization were significantly different among the two groups respectively.Conclusions Antenatal care is important in decreasing the incidence of early preterm birth.Early severe preeclampsia significantly affect fetal growth.The neonatal mortality rates are high in both early S-PE and spontaneous preterm birth.(Shanghai Med J,2007,30:513-516)