重度子痫前期患者再次妊娠血压状态及相关危险因素分析

目的分析重度子痫前期(sPE)患者再次妊娠的血压状态并分析相关危险因素。方法选择初次妊娠患sPE并再次妊娠的62例孕妇,根据血压等指标分为未再发生sPE组(包括血压正常和轻度子痫前期)和再次发生sPE组,比较2组患者前次妊娠及再次妊娠时的临床特征,采用单因素及多因素Logistic回归分析再次妊娠发生sPE的危险因素。结果单因素分析显示,2组孕妇在前次妊娠发病孕周、前次妊娠终止孕周、再次妊娠年龄、再次妊娠前BMI、是否规律产检和在孕早期(3个月内)服用阿司匹林等方面比较差异均有统计学意义(P均<0.05),而在前次妊娠发生严重产科并发症、前次妊娠胎儿生长受限、2次妊娠间隔时间、补充叶酸、补充钙剂以及是否妊娠期糖尿病等方面组间比较差异均无统计学意义(P均> 0.05)。多因素Logistic回归分析显示,再次妊娠年龄≥35岁(OR=9.148)、再次妊娠无规律产检(OR=5.921)和孕早期未予阿司匹林治疗(OR=4.797)均是sPE再次发生的危险因素(P均<0.05)。结论 sPE患者再次妊娠时年龄≥35岁,再次发生sPE风险升高,规律产检和在孕早期予阿司匹林治疗可...     

重度子痫前期并发不良结局149例危险因素分析

目的 探讨重度子痫前期发生不良结局患者的临床特征及危险因素分析.方法 选择2008年1月至2009年12月在天津市第一中心医院住院的重度子痫前期并发不良结局149例为观察组,同期住院的重度子痫前期未发生不良结局278例为对照组,比较临床特征及分析不良结局的危险因素.结果 (1)一般资料:2组年龄、产次比较差异无统计学意义;观察组发病孕周、终止孕周均小于对照组差异均有统计学意义(P均＜0.05＝;观察组与对照组无规律产检率比较差异亦有统计学意义(x2=8.515,P=0.002).(2)临床特征及化验指标:观察组尿蛋白定性试验及水肿程度高于对照组,胎儿生长受限发生率更高,差异均有统计学意义(P均＜0.05＝.观察组间接胆红素、总胆红素、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、尿酸、肌酐、白细胞、凝血酶时间、D-二聚体均高于对照组;白蛋白、血小板及纤维蛋白原低于对照组,差异均有统计学意义(P均＜0.05＝.(3)影响因素分析:logistic多因素分析回归分析显示发病孕周、规律产检与子痫前期并发不良结局关系最大(分别为OR=0.899,P＜0.001;OR=0.600,P=0.022＝;各种化验指标中,间接胆红素及D-二聚体与子痫前期并发症关系最显著(分别为OR=1.533,P=0.010;OR=1.001,P=0.003).眼底病变与平均动脉压及肌酐水平关系最大(分别为OR=1.030,P=0.048;OR=1.025,P=0.022).胎死宫内与规律产检最大(OR=0.317,P=0.046).(4)母儿预后:2组剖宫产率差异无统计学意义(P＞0.05).观察组娩出低出生体重儿率高于对照组,观察组新生儿评分明显低于对照组;观察组产时出血高于对照组,差异均有统计学意义(P均＜0.05＝.结论 发病孕周过早、无规律产检及出现胎儿窘迫是子痫前期并发不良结局的高危因素.间接胆红素及D-二聚体增高应警惕子痫前期不良结局发生.

Abstract：

Objective To explore clinical features of severe preeclampsia patients with adverse outcome, and the risk factors of adverse outcomes. Methods From Jan. 2008 to Dec. 2009 149 severepreeclampsia impatients who occurred adverse outcome enrolled as case,and 278 severe preeclampsia impatientswithout adverse outcome at the same period enrolled as control. The clinical features between the two groups were compared and the risk factors were investigated. Results No significant differences were found between the two groups in maternal age,times of previous prenancies. The gestation ages at the onset of preeclampsia and at delivery in the cases were less than controls(P ＜ 0. 05). There was significant difference in irregular antenatal checks between the two groups(x2 = 8. 515, P ＜ 0. 05). Proterinuria and the level of oedema in cases were higher than controls( P ＜ 0. 05). Fetal growth restriction (FGR) occurred more frequently in the cases (P ＜0. 05). Indirect bilirubin, total bilirubin, glutamic oxalacetic transaminase, glutamic pyruvic transaminase, uric acid, creatinine, white blood cell, thrombin time, D-dimeride of cases were higher than those of controls(Ps ＜0. 05). Albumin, platelet and profibrin of cases were lower than those of controls(Ps ＜ 0. 05 ＝. Multivariate logistic analysis showed that the gestation ages at the onset of preeclampsia, regular antenatal checks were significantly associated with adverse outcome(OR = 0. 899, P ＜ 0. 001; OR = 0. 600, P = 0. 022, respectively ＝Indirect bilirubin and D-dimeride were significantly associated with preeclampsia complications(OR = 1. 533,P =0. 010; OR = 1.001, P = 0. 003, respectively). Mean arterial pressure and creatinine were significantly associated with eyeground changes(respectively OR = 1. 030,P = 0. 048; OR = 1. 025, P = 0. 022, respectively).Regular antenatal checks was associated with dead fetus(OR = 0. 317, P = 0. 046). No significant differenceswere found between the two group in uterine-incision delivery(P ＞ 0. 05). Incidence rate of low birth weight infants and postpartum hemorrhage of cases were higher than controls and Apgar score was lower in cases than controls( all P ＜0. 05＝. Conclusion The gestation ages at the onset of preeclampsia,regular antenatal checks,fetal distress were risk factors for preeclampsia adverse outcome. Patients with.high indirect bilirubin and Ddimeride are more likely to suffer adverse pregnancy outcomes.     

重度子痫前期并发不良结局149例危险因素分析

Objective To explore clinical features of severe preeclampsia patients with adverse outcome, and the risk factors of adverse outcomes. Methods From Jan. 2008 to Dec. 2009 149 severepreeclampsia impatients who occurred adverse outcome enrolled as case,and 278 severe preeclampsia impatientswithout adverse outcome at the same period enrolled as control. The clinical features between the two groups were compared and the risk factors were investigated. Results No significant differences were found between the two groups in maternal age,times of previous prenancies. The gestation ages at the onset of preeclampsia and at delivery in the cases were less than controls(P ＜ 0. 05). There was significant difference in irregular antenatal checks between the two groups(x2 = 8. 515, P ＜ 0. 05). Proterinuria and the level of oedema in cases were higher than controls( P ＜ 0. 05). Fetal growth restriction (FGR) occurred more frequently in the cases (P ＜0. 05). Indirect bilirubin, total bilirubin, glutamic oxalacetic transaminase, glutamic pyruvic transaminase, uric acid, creatinine, white blood cell, thrombin time, D-dimeride of cases were higher than those of controls(Ps ＜0. 05). Albumin, platelet and profibrin of cases were lower than those of controls(Ps ＜ 0. 05 ＝. Multivariate logistic analysis showed that the gestation ages at the onset of preeclampsia, regular antenatal checks were significantly associated with adverse outcome(OR = 0. 899, P ＜ 0. 001; OR = 0. 600, P = 0. 022, respectively ＝Indirect bilirubin and D-dimeride were significantly associated with preeclampsia complications(OR = 1. 533,P =0. 010; OR = 1.001, P = 0. 003, respectively). Mean arterial pressure and creatinine were significantly associated with eyeground changes(respectively OR = 1. 030,P = 0. 048; OR = 1. 025, P = 0. 022, respectively).Regular antenatal checks was associated with dead fetus(OR = 0. 317, P = 0. 046). No significant differenceswere found between the two group in uterine-incision delivery(P ＞ 0. 05). Incidence rate of low birth weight infants and postpartum hemorrhage of cases were higher than controls and Apgar score was lower in cases than controls( all P ＜0. 05＝. Conclusion The gestation ages at the onset of preeclampsia,regular antenatal checks,fetal distress were risk factors for preeclampsia adverse outcome. Patients with.high indirect bilirubin and Ddimeride are more likely to suffer adverse pregnancy outcomes.     

早发型重度子痫前期胎儿不良围产结局及其影响因素分析

目的探讨早发型重度子痫前期胎儿不良围产结局及其危险因素。方法对89例单胎妊娠、接受期待治疗的早发型(发病孕龄24～34周)重度子痫前期患者的住院病例进行回顾性分析。结果不同发病孕龄的产妇其胎儿不良结局的发生率比较差异具有统计学意义(P<0.01);发病孕龄和入住房间床位数是胎儿围产结局的影响因素。结论入住房间床位数是胎儿发生不良围产结局的危险因素,发病孕龄是胎儿发生不良围产结局的重要保护因素,医务工作者应积极努力查找早发型重度子痫前期的发病原因,做好孕期保健,预防疾病的发生。     

重度子痫前期产妇产褥期的危险因素及预见性护理

目的探究重度子痫前期危险因素,并制定预见性护理方案。方法研究组33例行预见性护理,对照组22例行常规护理,探究危险因素行Logistic回归分析,并针对危险因素提出预见性护理措施。结果重度子痫前期的诱发危险因素较多,经Logistic回归分析显示年龄≥35岁、体质量指数(BMI)≥28.0、未规律产检、高血压病史、负性情绪为独立危险因素。针对相关危险因素采取预见性护理干预后,研究组产妇的产后出血、子痫、心衰、HELLP综合征等并发症发生率显著降低(P0.05),焦虑、抑郁症状显著改善(P0.05)。结论针对重度子痫前期产妇的危险因素给予预见性护理干预,能减少产褥期并发症,保证女性安全。     

重度子痫前期发病孕周对妊娠结局的影响

目的探讨重度子痫前期发病孕周对妊娠结局的影响。方法将108例重度子痫前期单胎孕产妇按照发病时间的不同分为早发型组(49例)和晚发型组(59例)。另随机抽取同期的32例检查指标正常单胎孕产妇作为正常组。分析三组的临床资料,比较早发型组与晚发型组孕产妇的血压情况、期待治疗时间及终止妊娠方式。结果三组的分娩次数、终止妊娠孕周、入院时收缩压及入院时舒张压比较,差异具有统计学意义(P<0.05);晚发型组的发病孕周大于早发型组,入院时24 h尿蛋白定量水平低于早发型组(P<0.05)。产后12周,早发型组的血压异常发生率、收缩压均高于晚发型组(P<0.05)。早发型组的期待治疗时间长于晚发型组(P<0.05);两组的终止妊娠方式比较,差异具有统计学意义(P<0.05)。结论早发型、晚发型重度子痫前期孕妇结束妊娠的方式均以剖宫产为主,但早发型孕产妇结束妊娠孕周小、引产率较高。     

妊娠合并重度子痫前期围生结局分析

目的分析重度子痫前期对围生结局影响。方法回顾及比较2018年6月30日至2018年12月31日因重度子痫前期(重度组)、子痫前期(非重度组)及同期无妊娠合并症(对照组)住院并分娩的孕妇及其后代的情况。结果重度组的高龄孕妇占比和双胎率均大于对照组,差异有统计学意义(P0.05)。重度组的双胎率高于非重度组和对照组,差异有统计学意义(P0.05)。重度组分娩时孕周、阴道分娩率低于非重度组和对照组,差异有统计学意义(P0.05)。重度组剖宫产率、早产率、引产率均高于非重度组和对照组,差异有统计学意义(P0.05)。重度组住院时间长于非重度组和对照组,差异有统计学意义(P0.05)。重度组妊娠期糖尿病发生率低于非重度组,差异有统计学意义(P0.05)。但胎儿宫内生长受限发生率远高于非重度组和对照组,差异有统计学意义(P0.05)。其余指标比较,差异无统计学意义(P0.05)。重度组新生儿平均出生体质量、出生后阿普加评分均低于非重度组和对照组,差异有统计学意义(P0.05)。低体质量新生儿占比高于非重度组和对照组,差异有统计学意义(P0.05)。结论重度子痫前期是威胁母婴健康的严重妊娠期并发症,临床中应遵循早发现、早诊断、早处理等原则,以延缓病情进展,改善母婴结局。     

影响重度子痫前期孕妇及围产儿预后的相关因素

目的 了解影响重度子痫前期孕妇及围产儿预后的相关因素.方法 采用以医院为基础的方法 收集回顾性资料,共纳入157例研究样本.采用SAS8.2对孕产儿结局的危险因素进行单因素分析和多因素Logistic回归分析.结果经单因素和多因素分析,入院时血压与妊娠终止时孕妇的并发症有关,重度高血压孕妇发生并发症的危险是轻度高血压孕妇的3.147倍（95%CI：1.483～6.679）.32～36孕周终止妊娠是新生儿窒息发生的保护因素,期间所产新生儿窒息发生的危险是≤27孕周的0.026倍（95%CI：0.004～0.169）.结论 重度子痫前期孕妇的入院时血压情况（重度高血压）是孕妇预后的危险因素,32～36孕周终止妊娠是围产儿并发症发生的保护因素.     

TEG、凝血常规、血小板计数检测应用于重度子痫前期孕妇的价值分析

目的:分析血栓弹力图(TEG)、凝血常规、血小板计数检测应用于重度子痫前期孕妇的临床价值.方法:选取2018年1月～2019年12月我科收治的115例重度子痫前期孕妇作为研究对象,并选取同期产检孕妇115例作为对照组,均完善TEG、凝血常规、血小板计数检查,并比较两组间上述检查指标水平.结果:较对照组,重度子痫前期孕妇...     

重度子痫前期终止妊娠时机及妊娠结局分析

目的 分析重度子痫前期的并发症及其妊娠结局,寻求终止妊娠最佳时机和方式.方法 对203例孕23+3～39+3周重度子痫前期患者临床资料进行回顾性分析,比较不同孕周终止妊娠者分娩方式及母婴预后的差异.结果 重度子痫前期并发低蛋白血症69例,并发心衰4例,胎盘早剥15例,胎儿宫内发育迟缓19例,产后出血42例,溶血、肝酶升高、低血小板综合征(HELLP)3例;孕34～36周分娩组剖宫产率最高,与其他两组比较差异有显著性意义(P<0.05);新生儿窒息率和围生儿死亡率在孕28～33周组最高,孕34～36周组和≥37孕周组比较差异无显著性意义(P>0.05).结论 重度子痫前期并发症随着孕周增加而增多,适时终止妊娠可减少母婴并发症,降低围产儿死亡.     

重度子痫前期发病类型对妊娠结局影响的研究

目的探讨重度子痫前期发病类型对妊娠结局的影响。方法回顾性分析收治的106例诊断为重度子痫前期的患者,根据发病孕周分为两组,孕周≤34周的为早发型组(63例),而孕周>34周的为晚发型组(43例)。分析比较两组孕妇并发症的发生情况及围生儿情况。结果两组患者保守治疗时间比较,早发组和晚发组平均治疗时间分别为(7.52±4.3)d、(4.21±1.6)d,差异有统计学意义。两组孕产妇并发症发生情况比较,早发组有58例,晚发组有32例,并发症发生率差异有统计学意义。两组不同类型重度子痫对围生儿的影响:早发组中有50例胎儿生长受限,晚发组中有21例,早发组的胎儿生长受限率显著较高。结论早发型重度子痫患者对孕产妇及胎儿的影响较晚发型大,较易发生各种并发症和多器官损害。     

重度子痫前期孕妇所生早产儿脑损伤的超声评价

目的 分析重度子痫前期孕妇所生早产儿的颅脑超声检查结果,探讨超声对脑损伤疾病的诊断价值,以期为临床早期诊断、治疗及干预提供依据.方法 对36例重度子痫前期孕妇和40例无高危围产因素孕妇所生早产儿行颅脑超声检查,分析两组脑损伤发病率和疾病分布构成的差异性.结果 重度子痫前期组36例早产儿中颅脑超声图像异常者26例,声像图异常率72.2％;对照组40例早产儿中颅脑超声图像异常者19例,声像图异常率47.5％,两者比较差异有统计学意义(P＜0.05).两组超声异常图像脑室周围-脑室内出血和早产儿脑室周围白质损伤的分布构成比较差异无统计学意义.结论 重度子痫前期孕妇可增加其早产儿脑损伤疾病的发生率,超声是一种有效的新生儿脑异常的检出手段,能为临床早期诊断、治疗及干预提供依据.     

高龄孕妇妊娠结局及其分娩相关危险因素研究

目的探讨二胎政策下高龄孕妇妊娠结局及其分娩相关危险因素。方法选取2018年1—12月我院分娩的138例高龄产妇为研究对象,根据妊娠结局分为正常组(n=88)和不良妊娠结局组(n=50),通过问卷调查的方式,调查研究对象的相关信息,采用单因素和多因素logistic回归模型分析分娩相关危险因素与妊娠结局关联情况。结果单因素分析显示,体质量、多次流产、妊娠高血压、孕期保健是不良妊娠结局的危险因素(P<0.05)。多因素logistic分析结果显示,体质量、多次流产、妊娠高血压是不良妊娠结局的独立危险因素(P<0.05),而孕期保健是不良妊娠结局的保护因素(P<0.05)。体质量、流产次数、妊娠高血压与不良妊娠结局及分娩呈正相关(P<0.05),孕期保健与不良妊娠结局及分娩呈负相关(P<0.05)。结论体质量、多次流产、妊娠高血压、孕期保健是引起不良妊娠结局的相关危险因素。因此明确妊娠结局的相关危险因素,提供相应的护理措施,鼓励产妇增加产检次数以及孕期保健,对避免不良妊娠结局的发生具有重要意义。     

重度子痫前期患者脐动脉血流动力学指标预测围产儿不良妊娠结局的价值

目的探讨重度子痫前期患者脐动脉血流动力学指标预测围产儿不良妊娠结局的价值。方法选取我院2017年4月至2018年4月收治的58例重度子痫前期患者作为研究组,选取同时期来我院孕检的58例健康孕妇作为对照组。比较两组的脐动脉血流动力学指标异常情况、不良妊娠结局;比较研究组血流动力学正常及异常者不良妊娠结局发生情况。结果对照组的血流动力学异常率明显低于研究组(P<0.05)。对照组新生儿窒息、低出生体重、胎儿窘迫及胎儿生长受限的发生率均明显低于研究组(P<0.05)。研究组血流动力学正常者新生儿窒息及胎儿窘迫的发生率均明显低于异常者(P<0.05)。结论重度子痫前期患者脐动脉血流动力学指标异常会导致不良妊娠结局发生率升高,应及时采取相关措施进行改善。     

Maternal plasma concentrations of insulinlike growth factor-1 and insulinlike growth factor-binding protein-1 in early pregnancy and subsequent risk of preeclampsia

OBJECTIVES: We investigated the relationship between maternal plasma free insulinlike growth factor-1 (IGF-1) and insulinlike growth factor-binding protein-1 (IGFBP-1) concentrations and risk of preeclampsia. DESIGN AND METHODS: Maternal blood samples were collected at 13 weeks' gestation on average. From the cohort, we selected 53 women who developed preeclampsia and 477 who remained normotensive. Free IGF-1 and IGFBP-1 concentrations were measured using immunoassays. Logistic regression procedures were used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: Women who developed preeclampsia had 18% and 27% lower concentrations of free IGF-1 and IGFBP-1, respectively, than controls (P < 0.05). There was a 57% reduced risk of preeclampsia among women with free IGF-1 concentrations of >or= 0.81 ng/mL (OR = 0.43, 95% CI 0.23-0.83) and a 43% reduced risk among women with IGFBP-1 concentrations of >or= 72.36 ng/mL (OR = 0.53, 95% CI 0.23-1.21). CONCLUSIONS: Alterations of free IGF-1 and IGFBP-1 concentrations in maternal plasma during early pregnancy are associated with risk of preeclampsia. These associations may help to further elucidate the pathologic processes of preeclampsia.     

Migraine is a risk factor for hypertensive disorders in pregnancy: a prospective cohort study

The aim was to assess whether women suffering from migraine are at higher risk of developing hypertensive disorders in pregnancy. In a prospective cohort study, performed at antenatal clinics in three maternity units in Northern Italy, 702 normotensive women with singleton pregnancy at 11–16 weeks' gestation were enrolled. Women with a history of hypertensive disorders in pregnancy or presenting chronic hypertension were excluded. The presence of migraine was investigated according to International Headache Society criteria. The main outcome measure was the onset of hypertension in pregnancy, defined as the occurrence of either gestational hypertension or preeclampsia. Two hundred and seventy women (38.5%) were diagnosed with migraine. The majority (68.1%) suffered from migraine without aura. The risk of developing hypertensive disorders in pregnancy was higher in migraineurs (9.1%) compared with non-migraineurs (3.1%) [odds ratio (OR) adjusted for age, family history of hypertension and smoking 2.85, 95% confidence interval (CI) 1.40, 5.81]. Women with migraine also showed a trend to increased risk for low birth weight infants with respect to women without migraine (OR 1.97, 95% CI 0.98, 3.98). Women with migraine are to be considered at increased risk of developing hypertensive disorders in pregnancy. The diagnosis of primary headaches should be taken into account at antenatal examination.     

三维功率多普勒超声评价重度子痫前期孕妇肾脏血流灌注

目的探讨三维功率多普勒超声（3D-PDUS）评估重度子痫前期孕妇肾脏血流灌注的价值。 方法选择2016年6月至2017年8月在江阴市人民医院确诊的重度子痫前期孕妇34例（观察组）及正常妊娠孕妇36例（对照组）,应用三维功率多普勒超声及虚拟器官计算机辅助分析（VOCAL）技术,分别测量并比较两组孕妇3项肾脏血流灌注参数：血管指数（VI）、血管化血流指数（VFI）及血流指数（FI）。 结果观察组34例重度子痫前期孕妇与对照组正常妊娠孕妇肾脏血流灌注参数VI测值比较［（48.211±7.369）% vs （60.751±5.893）%］差异有统计学意义（t=7.835,P<0.01）;且两组孕妇肾脏血流灌注参数VFI测值比较（11.753±1.743 vs 16.273±2.749）差异亦有统计学意义（t=8.264,P<0.01）;表明重度子痫前期孕妇肾脏血流灌注量较少;而观察组与对照组孕妇肾脏血流灌注参数FI测值比较差异无统计学意义。 结论3D-PDUS技术对评估重度子痫前期孕妇肾脏血流灌注状况有重要诊断价值。     

Pregnancy-induced hypertension and preeclampsia: levels of angiogenic factors in malaysian women

Preeclampsia (PE) is a major contributor to maternal and fetal mortality. The cause of preeclampsia remains unclear, but oxidative stress on the endothelium leading to endothelial dysfunction is said to be the root cause of the disease. The aim of this study was to measure and determine the plasma levels of key angiogenic factors in pregnancy as an indicator for the early onset of preeclampsia in pregnancy. Plasma levels of circulating a soluble fms like tyrosine kinase-1 (sFlt-1), an anti-angiogenic factor, vascular endothelial growth factor (VEGF) and placental growth factor (PIGF), both pro-angiogenic factors were analyzed in normal pregnant Malaysian women (control group, n = 34), women with pregnant induced hypertension (PIH, n = 34) and women with preeclampsia (PE, n = 34) all at three gestational ages, 24–28 weeks (early pregnancy: EP), 32–36 weeks (late pregnancy: LP) and 6 weeks after delivery (postpartum: PN). The plasma levels of angiogenic factors were determined by ELISA. sFlt-1 levels were elevated in PIH and PE patients as compared to controls. PIGF and VEGF were significantly decreased in PIH and PE as compared to the controls. These results suggest that elevated concentration of sFlt-1 and suppressed levels of PIGF and VEGF may contribute to the development of hypertension in pregnancy which precedes preeclampsia.