早发型重度子痫前期发病孕周与母儿预后的关系

目的探讨早发型重度子痫前期的发病孕周与母儿预后的关系。方法回顾性分析2002年1月至2006年12月北京大学第一医院分娩的266例孕28-36周发病的单胎重度子痫前期患者的临床资料,按重度子痫前期发病孕周分为4组,Ⅰ组孕28-30周50例;Ⅱ组孕30^＋1-32周72例;Ⅲ组孕32^＋1-34周78例;Ⅳ组组孕34^＋1-36周66例。比较这4组的临床特点和母儿并发症。结果Ⅰ组孕妇有不良产史者明显高于Ⅱ组、Ⅲ组、Ⅳ组（32%vs 8.3%、5.1%、6.0%,P〈0.05）;Ⅰ组孕妇有子痫前期史者明显高于Ⅱ组、Ⅲ组、Ⅳ组（24%vs 5.5%、0%、9.0%,P〈0.05）;保守治疗时间Ⅰ组（19±23）d,Ⅱ组（10±10）d,分别明显高于Ⅲ组（6±9）d、Ⅳ组（5±7）d,（P〈0.05）;24 h尿蛋白定量平均为Ⅰ组（6.2±4.9）g,明显高于Ⅱ组（4.8±2.9）g、Ⅲ组（4.0±3.0）g、Ⅳ组（2.8±2.1）g,（P〈0.05）;围产儿死亡率Ⅰ组和Ⅱ组分别为48%、16.6%,明显高于Ⅲ组和Ⅳ组的5.1%、3.0%,P〈0.05;新生儿RDS的发生率Ⅰ组为24%、Ⅱ组为30.5%,分别明显高于Ⅲ组的2.5%、Ⅳ组的12.1%,P〈0.05;孕妇并发症各组之间分析比较差异无统计学意义。结论重度子痫前期发病孕周早晚和保守治疗时间长短与孕妇并发症的发生无关。孕32周之前发病的重度子痫前期的围产儿死亡率及新生儿RDS发生率明显高于孕32周之后发病者。孕妇的不良产史及子痫前期史与重度子痫前期的发病时间相关。

The relationship between the onset gestational age and maternal and perinatal prognosis in early-onset severe preeclampsia

Objective To investigate the relationship between the onset gestational age and the maternal and perinatal prognosis in the early-onset severe preeclampsia.Methods Retrospective analysis was conducted on the clinical data of 266 severe preeclampsia patients who were diagnosed before 36 gestational weeks in Peking University First Hospital from January 2002 to December 2006.All the patients were divided into four groups： group Ⅰ（n=50） with the onset time at 28-30 weeks;group Ⅱ（n=72） at 30^＋ - 32 weeks;group Ⅲ（n=78） at 32^＋ - 34 weeks;group Ⅳ（n=66） at 34^＋ - 36 weeks.The maternal and perinatal outcomes were compared.Results The expectant management time of group Ⅰ （19±23）d]and group Ⅱ（10±10）d] was significantly longer than group Ⅲ （6±9）d ] and Ⅳ （5±7）d],（P〈0.05）.24-hour urine protein of group Ⅰ was significantly higher than group Ⅱ,Ⅲ and Ⅳ （6.2±4.9）g vs.4.8±2.9）g,（4.0±3.0）g,（2.8±2.1）g,P〈0.05].Perinatal mortality（48% and 16.6% vs.5.1% and 3.0%,P〈0.05） and the incidence of neonatal RDS（24% and 30.5% vs.2.5% and 12.1%,P〈0.05） in group Ⅰ and group Ⅱ were significantly higher than that in group Ⅲ and group Ⅳ.Maternal complications among the groups showed no statistical difference.Conclusions The gestational age of the onset of severe preeclampsia and expectant management time were unrelated to the maternal outcome.Severe preeclampsia occurred before 32 weeks was associated with higher perinatal mortality and neonatal RDS.The previous pre-eclampsia and poor obstetric history were associated with the onset time of severe preeclampsia