妊娠期高血压疾病严重程度与母婴结局的关系及危险因素分析

目的探讨妊娠期高血压疾病严重程度与母婴结局的关系及危险因素。方法选取2016年6月-2017年9月该院126例妊娠期高血压疾病患者作为病例组,其中妊娠期高血压49例,轻度子痫前期42例,重度子痫前期35例;另选取88例正常妊娠者作为正常组,对比两组临床资料,统计产妇临床资料、产妇结局、新生儿并发症,并分析影响妊娠期高血压疾病发生的危险因素。结果重度子痫前期组产妇不良预后总发生率显著高于妊娠期高血压组、轻度子痫前期、正常组,重度子痫前期组早产、胎盘早剥、心力衰竭发生率显著高于正常组(P<0. 05)。重度子痫前期组新生儿不良预后总发生率显著高于妊娠期高血压组、轻度子痫前期、正常组,新生儿窒息发生率显著高于轻度子痫前期、正常组,胎儿窘迫发生率显著高于正常组(P<0. 05)。单因素分析发现,年龄、BMI、孕次、产次、睡眠时间、孕期并发症、高血压史、高血压家族史方面与妊娠期高血压疾病发生相关,另经Logistic多因素回归分析显示,年龄、BMI、产次、妊娠高血压史、高血压家族史是妊娠期高血压发生的危险因素。结论妊娠期高血压疾病对母婴结局影响极大,而影响妊娠期高血压疾病发生的原因有年龄、BMI、产次、高血压史、高血压家族史等,应对以上危险因素的产妇加强相应的防治措施。     

妊娠高血压疾病的发病因素与母婴不良结局的关系

目的:分析妊高症的发病因素与母婴不良结局之间存在的关系,便于制定对应的治疗及护理措施。方法:对我院收治的150例妊高疾病患者的临床资料展开回顾性分析。计算母婴不良结局的发生率并分析不良结局与患者相关资料的具体关系。结果:母婴不良结局的总发生率为74.66%(112/150),其中包括母亲不良结局27.33%(41/150)、胎儿不良结局24%(36/150)、婴儿不良结局23.33%(35/150)。妊娠期高血压疾病母婴不良结局与疾病严重程度、发病孕周、分娩孕周、蛋白尿程度存在直接的关联性,差异比较均得到P0.05,具有统计学差异。结论:妊娠期高血压疾病可加大母婴不良结局的发生几率,需要医护人员加强控制与管理。     

妊娠期高血压疾病危险因素的Logistic回归分析

目的:探讨不同危险因素对妊娠期高血压疾病患者以及围生儿不良妊娠结局的影响。方法:对收治的209例妊娠期高血压疾病患者的妊娠高血压疾病程度、尿蛋白程度、发病孕周以及分娩孕周的相关危险因素对不良妊娠结局的影响进行Logistic回归分析。结果:对于患者主要相关因素为尿蛋白程度及发病孕周(P<0.01);对于胎儿以及新生儿其相关因素为尿蛋白程度及分娩孕周(P<0.01)。结论:对于妊娠期高血压疾病患者应当严格控制病情的发展,并对蛋白尿等相关疾病进行及时的纠正,并在尽可能情况下延长分娩孕周以减少患者及围生儿发生不良妊娠结局的机会。     

武汉市妊娠期高血压疾病及其不良妊娠结局大样本流行病学分析

目的:通过流行病学分析了解武汉市妊娠期高血压疾病(PIH)及其不良妊娠结局的发生情况,进一步探讨PIH对妊娠结局的影响。方法:回顾性分析2011年武汉市83 761例孕产妇产时相关资料,分析妊娠期高血压疾病组与非妊娠期高血压疾病孕产妇的不良妊娠结局发生情况。结果:2011年武汉市共发生妊娠期高血压疾病3 064例,发生率为3.67%。城镇孕产妇发生率高于农村孕产妇,经产妇高于初产妇,多胎高于单胎,孕产妇年龄越大发生率越高,PIH孕产妇组的产后出血、胎盘早剥、新生儿窒息、早产、剖宫产、死胎、新生儿死亡及低出生体重(体重<2 500 g)的发生率明显高于非妊娠期高血压疾病孕产妇。子痫不良妊娠结局的发生率明显高于妊娠期高血压和子痫前期患者。结论;武汉市PIH发生率处于较低水平,PIH的发生与城乡、年龄、产次、多胎相关,PIH增加母婴不良妊娠结局,应加强对孕产妇保健管理,减轻PIH疾病危害,改善母婴结局,降低孕产妇和新生儿并发症及死亡率。     

35岁以上初产妇不良妊娠结局及其相关危险因素分析

目的研究35岁以上初产妇不良妊娠结局,并对其相关危险因素进行分析。方法回顾性分析2015年7月至2017年7月于武警后勤学院附属医院分娩的初产妇2 362例的临床资料,根据年龄将研究对象分为高龄组405例(≥35岁),适龄组1 957例(20~34岁)。根据是否发生不良妊娠结局,将高龄组进一步分为不良结局组67例,正常分娩组338例。对可能造成不良妊娠结局的危险因素进行单因素分析,筛选出相关危险因素,对筛选因素再进行多因素Logistic回归分析35岁以上初产妇不良妊娠结局的独立危险因素。结果高龄组妊娠合并症的发生率为42.72%(173/405),适龄组为40.06%(786/1957);高龄组妊娠并发症的发生率为47.65%(193/405),适龄组为44.71%(875/1957)。其中高龄组在妊娠并发贫血、子宫肌瘤、妊娠期高血压疾病、妊娠期糖尿病、前置胎盘的发生率均高于适龄组,差异有统计学意义(P0.05)。对高龄产妇不良妊娠结局的多因素Logistic回归分析可见:妊娠期高血压疾病(OR=2.133,P=0.032)、前置胎盘(OR=4.256,P=0.025)、子宫收缩乏力(OR=7.853,P=0.019)为不良妊娠结局的独立危险因素。结论 35岁以上初产妇不良妊娠结局发生率高于适龄产妇。妊娠期高血压疾病、前置胎盘、子宫收缩乏力均为不良妊娠结局的独立危险因素。     

妊娠期高血压疾病对高龄产妇妊娠结局的影响

目的分析妊娠期高血压疾病对高龄产妇妊娠结局的影响。方法选取2016年12月-2018年12月台州市立医院收治的150例妊娠期高血压疾病高龄产妇为研究组,另选取同期收治的100例妊娠期高血压疾病非高龄产妇为对照组。比较两组产妇妊娠期并发症发生率、剖宫产率、产后出血量、围生儿不良结局发生率。结果研究组产妇妊娠期并发症发生率为20.67%,显著高于对照组的7.00%(P0.05)。研究组产妇剖宫产率和产后出血量均显著高于对照组(均P0.05)。研究组围生儿不良结局发生率为18.67%,显著高于对照组的6.00%(P0.05)。结论高龄产妇并发妊娠期高血压疾病会对母婴妊娠结局造成较多的不良影响,需及时采用有效方案进行治疗或及时终止妊娠,以保障母婴安全。     

妊娠期高血压疾病对围产期结局的影响

目的:探讨不同程度妊娠期高血压疾病对围产期结局的影响。方法:对南京医科大学附属南京市妇幼保健院产科2004年1月~2006年9月113例妊娠期高血压疾病产妇进行回顾性队列研究,分组比较母婴结局。结果:妊娠期高血压(≥160/110 mmHg)组不良妊娠结局发生率明显高于轻度子痫前期以及正常血压组和妊娠期高血压(≥140/90 mmHg,<160/110mmHg)组(P<0.05)。结论:高血压与妊娠期高血压疾病的病情及围产儿预后密切相关。不仅可作为临床监测指标,而且对诊断和治疗以及改善母婴预后均有十分重要的意义。     

足月胎膜早破危险因素及妊娠结局分析

目的探讨足月胎膜早破(TPROM)的危险因素及其对母婴妊娠结局的影响。方法选取240例TPROM产妇作为观察组,另随机选取240例未发生TPROM的产妇为对照组,筛选影响TPROM发生的相关危险因素,比较两组母婴妊娠结局分布的差异性。结果影响TPROM发生的危险因素包括引产流产史(OR=2.392)、生殖道感染(OR=4.459)、妊娠期高血压疾病(OR=3.031)、瘢痕子宫(OR=2.849)、胎位异常(OR=3.626)、腹压增加(OR=5.238)等;观察组产妇产后出血、产褥感染、胎儿窘迫、新生儿窒息、新生儿肺炎等发生率均高于对照组产妇,差异有统计学意义(P0.05)。结论 TPROM的发生与引产流产史、生殖道感染、妊娠期高血压疾病、瘢痕子宫、胎位异常、腹压增加等密切相关,而且TPROM还会引起不良妊娠结局发生率升高,影响母婴健康和安全。     

高龄初产妇不良妊娠结局及其相关危险因素分析

目的分析高龄初产妇不良妊娠结局及其相关危险因素。方法于2014年1月-2016年10月期间,选择在山东省无棣县水湾中心卫生院分娩的897例初产妇为研究对象,进行回顾分析,按照分娩年龄分为两组:高龄组(≥35岁)158例、适龄组(20~34岁)739例,比较两组产妇的不良妊娠结局情况,在此基础上将高龄组产妇分为不良妊娠结局组(39例)、正常分娩组(119例),并分析不良妊娠结局的危险因素。结果高龄组产妇产后出血、早产、新生儿畸形、新生儿窒息、低体重儿、巨大儿、先天疾病及不良妊娠结局总发生率均明显高于适龄组,差异有统计学意义(P0.05)。不良妊娠结局组产妇流产史、妊娠期高血压、妊娠期糖尿病、前置胎盘、剖宫产、胎盘粘连/植入、心电图异常、凝血功能障碍百分比明显高于正常分娩组,差异有统计学意义(P0.05)。经多因素回归分析证实流产史、妊娠期高血压、妊娠期糖尿病、前置胎盘、剖宫产、胎盘粘连/植入、心电图异常、凝血功能障碍是不良妊娠结局发生的独立危险因素(P0.05)。结论高龄初产妇不良妊娠结局发生率明显高于适龄组,流产史、妊娠期高血压、妊娠期糖尿病、前置胎盘、剖宫产、胎盘粘连/植入、心电图异常、凝血功能障碍是不良妊娠结局发生的独立危险因素。     

GDM并发甲状腺功能减退症影响因素及对母婴结局的影响

目的：探讨妊娠期糖尿病(GDM)并发甲状腺功能减退症的影响因素及对母婴结局的影响。方法：收集2020年1月-2023年1月于本院建档产前检查并在县内分娩的GDM并发甲状腺功能减退症产妇108例(并发组)、单纯GDM产妇134例(单纯组)临床资料,分析GDM并发甲状腺功能减退症影响因素及其母婴不良结局。结果：并发组孕次≥3次、产次≥3次、有甲状腺疾病史、有妊娠期高血压病史及有甲状腺疾病家族史的占比均高于单纯组(P<0.05),空腹血糖、肌酸肌酶、餐后2h血糖、肌酸肌酶同工酶、总胆固醇、尿酸、凝血酶时间、糖化血红蛋白及纤维蛋白原均高于单纯组,凝血酶原时间低于单纯组(均P<0.05);多孕次、多产次、有甲状腺疾病史、有妊娠期高血压病史、有甲状腺疾病家族史、低凝血酶原时间及高凝血酶时间是GDM并发甲状腺功能减退症的危险因素(P<0.05);并发组不良母婴结局总发生率(41.7%)高于单纯组(14.9%)(P<0.05)。结论：多孕次、多产次、有甲状腺疾病史、有妊娠期高血压病史、有甲状腺疾病家族史、低凝血酶原时间及高凝血酶时间是GDM并发甲状腺功能减退症的危险因素,且可能...     

妊娠期糖尿病孕妇血糖控制水平及对母婴妊娠结局的影响

目的 探讨妊娠期糖尿病(GDM)孕妇血糖控制水平及其对母婴妊娠结局的影响.方法 对374例确诊的GDM孕妇进行随访研究,根据其血糖控制达标情况分为控制良好组228例和控制不良组146例,比较两组孕妇血糖水平、妊娠并发症发生率、围生儿并发症发生率等指标.结果 治疗后374例GDM孕妇中血糖控制不良发生率为39.04％(1...     

小于胎龄儿发病相关危险因素分析

【目的】分析小于胎龄(small for gestational age,SGA)儿发病的相关危险因素,为临床防治提供参考。【方法】采用1∶2配对的病例对照研究方法,选取本院2005年1月～2006年12月出生的240例单胎活产SGA儿及同期出生的相同胎龄的适于胎龄儿(appropriate for gestational age,AGA)480例,应用Logistic回归分析方法,对其影响因素进行分析。【结果】多元回归分析显示:妊娠高血压综合症、既往异常妊娠史、母亲文化程度低、孕期被动吸烟与SGA发生有关联,其OR值分别为5.65、2.83、3.53、4.71。【结论】妊娠高血压综合症、既往异常妊娠史、母亲文化程度低、孕期被动吸烟,是SGA发生的危险因素,应从孕期保健做起,避免或减少SGA的发生。     

Adverse birth outcomes in United Republic of Tanzania--impact and prevention of maternal risk factors

OBJECTIVE: To determine risk factors for poor birth outcome and their population attributable fractions. METHODS: 1688 women who attended for antenatal care were recruited into a prospective study of the effectiveness of syphilis screening and treatment. All women were screened and treated for syphilis and other reproductive tract infections (RTIs) during pregnancy and followed to delivery to measure the incidence of stillbirth, intrauterine growth retardation (IUGR), low birth weight (LBW) and preterm live birth. FINDINGS: At delivery, 2.7% of 1536 women experienced a stillbirth, 12% of live births were preterm and 8% were LBW. Stillbirth was independently associated with a past history of stillbirth, short maternal stature and anaemia. LBW was associated with short maternal stature, ethnicity, occupation, gravidity and maternal malaria whereas preterm birth was associated with occupation, age of sexual debut, untreated bacterial vaginosis and maternal malaria. IUGR was associated with gravidity, maternal malaria, short stature, and delivering a female infant. In the women who had been screened and treated for syphilis, in between 20 and 34% of women with each outcome was estimated to be attributable to malaria, and 63% of stillbirths were estimated as being attributable to maternal anaemia. Screening and treatment of RTIs was effective and no association was seen between treated RTIs and adverse pregnancy outcomes. CONCLUSION: Maternal malaria and anaemia continue to be significant causes of adverse pregnancy outcome in sub-Saharan Africa. Providing reproductive health services that include treatment of RTIs and prevention of malaria and maternal anaemia to reduce adverse birth outcomes remains a priority.     

小于胎龄儿产科危险因素的病例对照研究

目的探讨产科因素及孕母文化程度与小于胎龄儿（SGA）之间的关系。方法采用病例对照方法，选取于2000年1月至2004年10月在第三医院出生的单胎活产SGA，全部病例共834例（男443例，女391例）作为病例组。以胎儿性别及出生胎龄进行频数匹配，按1：3的比例，采用完全随机抽样方法选取性别及胎龄别出生体重在10％～90％分位的适于胎龄儿2502名（男1329名，女1173名）为对照组，比较了病例组及对照组新生儿母亲年龄、文化程度及主要产科危险因素的比例。结果多因素logistic回归分析显示，SGA病例组母亲妊娠合并妊娠高血压综合征（妊高征）、羊水过少、有既往异常妊娠史和病毒性肝炎与对照组比较，OR值（95％Cj）分别为4．00（2．81～5．71）、2．95（2．27～3-83）、5．95（3．05～10．64）和0．50（0．30～0．84）；SGA母亲为初中及以下文化程度者与大专或以上文化程度者比较OR=3．46（95％CI：2．75～4．24）。其他因素与SGA无统计学意义的关联。结论孕母文化程度低、孕期合并妊高征、羊水过少、不良妊娠史可显著增加SGA发生的危险性。     

妊娠期高血压疾病与妊娠结局的相关性

目的:分析妊娠期高血压疾病发病的高危因素以及孕期保健与并发症之间、治疗方案选择与妊娠结局的关系,探讨降低妊娠期高血压疾病的发生率、减少并发症的措施,从而改善母婴结局。方法:回顾性分析我院2004年7月~2006年6月妊娠期高血压疾病患者587例,分析其高危因素、孕期产检情况与并发症发生的比例,妊高征治疗方案选择与妊娠结局的关系。结果:妊娠期高血压疾病高危因素多为肥胖、高龄、精神紧张、双胎、营养差者;并发症的发生率与产检次数成反比,产检越正规、次数越多,并发症发生机会越少,正规产检与不正规产检及从不产检者并发症发生率分别为22.82%、37.41%、63.38%,三者比较P<0.01,差异有显著性;妊娠期高血压疾病实施规范治疗方案与否与早产、低出生体重儿、新生儿窒息、早期新生儿死亡、子痫、心衰、胎盘早剥,差异有显著性。结论:大力宣传孕产期保健知识,加强流动人口管理,提倡正规产检,严格执行妊高征处理规范及三级转诊制度,可减少妊娠期高血压疾病及其并发症,改善母婴结局。     

Cumulative impact of early maternal marital age during the childbearing period

Early marriage of girls, close to age of menarche, is a widespread practice in Arab countries. Knowledge on the cumulative effect of early maternal marriage on maternal and infant health during the childbearing period is insufficient. The objectives of this study were to estimate the prevalence of early maternal marriage in Jeddah, identify its relation with other maternal risk factors, and investigate the cumulative impact of early maternal marriage on subsequent maternal health and pregnancy outcomes throughout the reproductive period. Data were collected from six randomly selected primary health care units in Jeddah City. Married women with an infant < or = 12 completed months of age were interviewed and information on sociodemographic characteristics, maternal health and previous pregnancy outcomes were collected. Early marriage of girls before the age of 16 years accounted for 26.5% of the study population and was reported by a third of mothers currently below the age of 20 years. Illiterate mothers, housewives, multiparae, smokers and those married to a relative reported the highest proportion of marriages before their sixteenth birthday. Those who married before the age of 16 were at about double the risk of developing chronic diseases and experiencing miscarriage, stillbirths and infant deaths. These results suggest that early maternal marriage still exists in our community and is intimately related to other maternal risk factors. Maternal marriage < 16 years appears to be fraught with insecurities for the mother and infant throughout the whole length of the childbearing period and not merely the first pregnancy. Thus, even if culture norms claim early marriage of girls, it should be discouraged before the age of 16 years. Moreover, it is recommended that future research on maternal and infant health considers the cumulative effect of the various risk factors during the whole reproductive period and not only a single pregnancy outcome.     

Effects of calcium supplementation during pregnancy on maternal, fetal and birth outcomes

Gestational hypertensive disorders are the second leading cause of maternal death worldwide. Epidemiological and clinical studies have shown that an inverse relationship exists between calcium intake and development of hypertension in pregnancy. The purpose of this review was to evaluate preventive effect of calcium supplementation during pregnancy on gestational hypertensive disorders and related maternal and neonatal morbidity and mortality. A literature search was carried out on PubMed, WHOLIS, PAHO and Cochrane Library. Only randomised trials were included in the review. Data were extracted into a standardised Excel sheet. Primary outcomes were pre-eclampsia, preterm birth and birthweight. Other neonatal outcomes such as neonatal mortality, small-for-gestational age and low birthweight were also evaluated. A total of 15 randomised controlled trials were included in this review. Pooled analysis showed that calcium supplementation during pregnancy reduced risk of pre-eclampsia by 52% [relative risk (RR) 0.48; 95% confidence interval (CI) 0.34, 0.67] and that of severe pre-eclampsia by 25% (RR 0.75 [95% CI 0.57, 0.98]). There was no effect on incidence of eclampsia (RR 0.73 [95% CI 0.41, 1.27]). There was a significant reduction for risk of maternal mortality/severe morbidity (RR 0.80 [95% CI 0.65, 0.97]). Calcium supplementation during pregnancy was also associated with a significant reduction in risk of pre-term birth (RR 0.76 [95% CI 0.60, 0.97]). There was an extra gain of 85 g in the intervention group compared with control (mean difference 85 g [95% CI 37, 133]). There was no effect of calcium supplementation on perinatal mortality (RR 0.90 [95% CI 0.74, 1.09]). There was a statistically non-significant increased risk of urolithiasis in the intervention group compared with control (RR 1.52 [95% CI 0.06, 40.67]). In conclusion, calcium supplementation during pregnancy is associated with a reduction in risk of gestational hypertensive disorders and pre-term birth and an increase in birthweight. There is no increased risk of kidney stones.     

妊娠期补钙与妊娠期高血压疾病不良妊娠结局发生的相关机制的研究进展

妊娠期高血压是一种孕期特有的并发症,是导致不良妊娠结局的主要原因。病因及发病机制尚未明确,终止妊娠仍为目前唯一有效的治疗方案,且不良妊娠结局如母体器官受累、早产、小于孕龄儿的发生也不可避免。许多研究证实妊娠期补钙情况与妊娠期高血压及其不良妊娠结局的发生有关且与其不良妊娠结局的严重程度有关。钙可直接或间接通过调节血管收缩及血管内皮活化作用来影响胎盘血流以致影响母体及胎儿。本文通过探讨妊娠期补钙与妊娠期高血压不良妊娠结局发生的相关机制的研究进展,可有助于了解妊娠期高血压患者妊娠期补钙的重要性,进一步了解补钙与妊娠不良结局严重程度的关系。     

Hypertensive disorders of pregnancy in jimma university specialized hospital

Background

Hypertensive disorders represent the most common medical complications of pregnancy with a reported incidence between 5 and 10%. The disorders are major causes of maternal and perinatal morbidities and mortalities. This study was conducted to determine the pattern and outcomes of pregnancies complicated by hypertensive disorders.

Methods

Hospital based cross-sectional study was conducted on all mothers who gave birth in the labor ward of Jimma University Specialized Hospital from April 1, 2009 to March 31, 2010. Data was collected by interviewing the mothers and review of their medical records using structured questionnaire and checklist, respectively. Data analysis was performed using SPSS for windows version 16.0.

Result

Majority (52.5%) of the mothers were in the age group of 25 - 34 years. The overall prevalence of hypertensive disorders of pregnancy was 8.5%. Severe preeclampsia accounted for 51.9% of the cases followed by eclampsia (23.4%). Residential area of the mothers (urban/rural) was found to have statistically significant association with severity of the disorder. Most (66.5% and 74.7%) of the mothers were nulliparous and had antenatal care follow-up during the index pregnancy, respectively. Antenatal care follow-up and parity had no statistically significant association with severity of the disease. The case fatality rate of hypertensive disorders of pregnancy was 1.3% with perinatal mortality of 317.1/1000 births.

Conclusion

Pregnancies complicated by hypertensive disorders have poor maternal and perinatal outcomes and rural women were more affected. Quality antenatal care services with good obstetric and neonatal care at delivery are essential for early recognition and management of hypertensive disorders of pregnancy.     

Low preconception body mass index is associated with birth outcome in a prospective cohort of Chinese women

Low maternal prepregnancy BMI is associated with adverse birth outcomes, but the BMI at which risk increases is not well defined. We assessed whether the relationship between prepregnancy BMI and birth outcomes is influenced by the extent to which mothers were underweight in a prospective study in Anhui, China. The women (n = 575) were 20-34 y old, married, nulliparous and nonsmokers. All measures of infant growth increased with increasing maternal BMI until a plateau was reached at a BMI of 22-23 kg/m2. Infants born to the 27% of women who were severely underweight before pregnancy (BMI < or = 18.5 kg/m2) were at increased risk for fetal growth deficits associated with infant morbidity. Compared with a normal BMI, being severely underweight was associated with mean (+/- SEM) reductions of 219 +/- 40 g in infant birthweight and 6.7 +/- 1.3% in the birthweight ratio and an 80% increase in risk of intrauterine growth restriction [odds ratio (OR) 1.8; 95% CI: 1.0, 3.3; P = 0.05]. Being severely underweight was also associated with smaller infant head circumference and lower ponderal index. Being moderately underweight (18.5 < BMI < 19.8 kg/m2) was not significantly associated with adverse pregnancy outcomes. Gestational age and risk of preterm birth were not associated with maternal BMI. More than half of the women in this study were underweight before pregnancy. Although being moderately underweight was not associated with increased risk of adverse pregnancy outcomes, being severely underweight was an important risk factor for reduced fetal growth.