宫腔粘连分离术后患者复发现状及其相关影响因素分析

目的探讨宫腔粘连分离术后患者复发现状及其相关影响因素。方法回顾性选取280例2018年1月至2020年12月于江苏省淮安市妇幼保健院行宫腔粘连分离术的患者,根据其是否复发为重度宫腔粘连分为重度组(n=28)和非重度组(n=252)。收集两组临床资料,并分析宫腔粘连分离术后患者复发为重度宫腔粘连的危险因素。结果 280例宫腔粘连分离术后患者复发为重度宫腔粘连28例(10.00%)。多因素Logistic回归分析结果显示,孕次、刮宫后闭经史、宫腔粘连分离频次、初次发现宫腔粘连时为重度是宫腔粘连分离术后患者复发为重度宫腔粘连的危险因素(OR=0.573;3.216;1.865;11.473, P 0.05)。结论宫腔粘连分离术后患者复发为重度宫腔粘连与患者孕次、刮宫后闭经史、宫腔粘连分离频次、初次发现宫腔粘连时为重度等有关,临床可据此给予患者针对性措施以降低宫腔粘连分离术后患者复发为重度宫腔粘连的风险。     

宫腔粘连研究进展

宫腔粘连（intrauterine adhesions,IUA）在临床上主要表现为闭经、月经过少、经期下腹痛、不孕等严重影响广大妇女的日常生活。IUA的治疗原则主要为手术分离粘连,术后辅助治疗促进子宫内膜的修复,而IUA术后预防再复发是IUA治疗中的重中之重,目前IUA分离术后再粘连的预防越来越得到学者们的关注。现将IUA的病因、诊治方法、治疗特别是预防IUA分离术后再粘连的方法的最新研究进展做一综述,以期指导临床。     

宫腔粘连分离术后预防再粘连的临床研究

<正>宫腔粘连(intrauterine adhesion,IUA)主要是由刮宫和感染引起的,临床主要表现为闭经或月经过少、周期性腹痛等。宫腔镜下行IUA分离术(transcervical resection of adhesions,TCRA)是在直视下有针对性地分离或切除IUA,是患者恢复正常月经、改善妊娠及分娩结局的标准方法,但术后可能发生宫腔再次粘连。2009年1月至2012年6月我院采用两种不同的治疗方法预防宫腔再次粘连,以探讨有效的预防方法。1资料与方法1.1一般资料选取上述期间江苏大学附属宜兴医院宫腔     

宫腔粘连形成的相关危险因素

宫腔粘连(IUA)是目前我国育龄期妇女继发不孕的常见原因之一。研究发现,各种对子宫内膜造成损伤的机械性因素尤其是刮宫手术是IUA形成的重要危险因素,而各种感染性、先天性因素以及子宫动脉栓塞术亦促进了IUA的形成。此外,分子生物学亦对阐明IUA的发生机制起着一定作用。现就IUA形成的临床及分子生物学相关危险因素进行综述。     

493例宫腔粘连患者的临床资料分析

目的:探讨宫腔粘连(IUA)患者粘连程度的高危影响因素。方法:回顾2012年1月至2014年6月北京大学第三医院生殖医学中心经宫腔镜确诊的493例IUA患者的临床资料,根据粘连程度分组,分析影响粘连程度的相关因素。结果:不同粘连程度IUA患者的平均年龄、月经周期和中孕妊娠丢失情况比较,差异均无统计学意义(P0.05);不同粘连程度IUA患者的月经量、原发不孕几率、结核病史和内膜炎情况均存在显著差异(P0.05);随着粘连程度的增加,经量减少、原发不孕及结核病史的患者所占的比例逐渐增加,而合并内膜炎患者的比例呈下降趋势。IUA粘连程度与妊娠相关的宫腔操作有关(P0.05),随着宫腔操作次数的增加,Ⅲ~Ⅴ度IUA患者明显增加。41.48%的IUA患者的子宫内膜超声结果正常,不同粘连程度患者的超声表现存在显著差异(P0.001),但随着粘连程度的加重,超声确诊粘连的比例无上升趋势。444例Ⅰ~Ⅲ度IUA患者中,内膜受损部位以中部居多,占45.05%;按粘连程度分组后,各组粘连部位存在统计学差异(P0.001),宫腔右侧粘连的比例明显高于左侧。结论:积极治疗感染性疾病,尽量减少宫腔创伤性操作,有助于避免IUA的发生;二维超声诊断IUA的敏感性低,宫腔镜检查是诊断IUA的金标准。     

胚物残留并发宫腔粘连的危险因素分析

目的:探讨胚物残留(RPOC)患者并发宫腔粘连(IUA)的危险因素。方法:回顾性分析2014年10月—2019年10月于首都医科大学附属北京妇产医院行宫腔镜手术治疗的115例RPOC患者的临床资料。按照宫腔镜手术术中是否诊断为IUA将其分为IUA组(30例)和非IUA组(85例),分析RPOC患者并发IUA的危险因素。结果:单因素分析显示,2组RPOC时间大于2个月、有妊娠期宫腔操作、残留胚物有血流信号者所占比例差异有统计学意义(均P<0.05)。多因素Logistic分析结果显示,有妊娠期宫腔操作(OR=4.005,95%CI:1.077~14.895,P=0.038)及RPOC时间大于2个月(OR=3.378,95%CI:1.076~10.603,P=0.037)均是RPOC并发IUA的危险因素。结论:临床中应重视RPOC患者并发IUA的危险因素,采取适当的措施,避免不必要的妊娠期宫腔操作,可在妊娠结束2个月内治疗RPOC,以降低发生IUA的风险。     

宫腔粘连分离术后预防粘连复发的方法及研究进展

宫腔粘连(intrauterine adhesions,IUA)是指由于多种因素导致子宫内膜基底层受损,临床症状主要表现为月经异常、不孕、复发性流产及早产、胎盘异常等产科相关并发症.宫腔镜手术是治疗IUA的标准术式,但是中、重度IUA患者术后的复发率较高,严重影响患者的生殖预后.目前临床上预防术后粘连复发的方法包括雌激...     

宫腔粘连分离术后预防再次粘连的研究进展

宫腔粘连(IUA)是因各种宫腔操作引起的子宫内膜损伤性疾病,亦称为Asherman综合征。近年,IUA发生率呈不断增长的趋势。随着宫腔镜技术的持续发展,宫腔镜下粘连分离术(TCRA)取得了一定的疗效。粘连易复发,因此术后粘连的预防尤为关键。本文较全面地总结IUA术后预防再次粘连的各种方法,为临床预防术后粘连的相关治疗提供依据。     

宫腔镜宫腔粘连分离术后子宫内膜对不同剂量雌激素的反应及其与生殖预后改善的关系

目的:探讨宫腔镜宫腔粘连分离术(TCRA)后子宫内膜对不同剂量雌激素的反应与生殖预后改善之间的关系.方法:选择2016年1月至2020年1月就诊于宁夏医科大学总医院妇科宫腔镜中心确诊并接受以TCRA手术为主的综合治疗的中、重度宫腔粘连(IUA)患者163例为研究对象,其中,IUA中度114例,IUA重度49例;每组内术...     

中重度宫腔粘连的高危因素分析

目的:探讨引起中重度宫腔粘连(IUA)的高危因素，为临床上预防IUA提供参考。方法:选择2019年1月至2020年2月重庆市妇幼保健院收治的157例IUA患者为研究对象，按照IUA的严重程度分为轻度IUA组(53例)和中重度IUA组104例，比较两组患者的病史情况、宫腔操作类型及宫腔感染(子宫内膜结核)等指标，探讨中重度IUA发生的高危因素。结果:(1)中重度IUA组与轻度IUA组患者的年龄、不孕史、复发性流产(RSA)史、非妊娠宫腔操作史、早期人工流产次数及子宫内膜结核史组间差异无统计学意义(P>0.05);而病程、宫腔操作次数、稽留流产清宫史、妊娠中晚期产后清宫史组间差异有统计学意义(P<0.05)。其中，病程>1年的患者发生中重度IUA的概率显著高于病程≤1年患者，差异有统计学意义(P<0.05);宫腔操作次数≥3次的患者发生中重度IUA的概率显著高于2次及≤1次患者，差异有统计学意义(P<0.05);有稽留流产清宫史及妊娠中晚期产后清宫史的患者均较无稽留流产清宫史及妊娠中晚期产后清宫史的患者发生中重度IUA的概率高，差异有统计学意义(P<0....     

Meta-analysis on the use of hyaluronic acid gel to prevent recurrence of intrauterine adhesion after hysteroscopic adhesiolysis

Intrauterine adhesion is a severe complication after intrauterine operation, Various adjuvant therapies failed to improve clinical symptoms and pregnancy rates among patients with moderate-to-severe intrauterine adhesion. At present, hyaluronic acid gel is widely used in the primary prevention of adhesion after hysteroscopic adhesiolysis. However, its efficacy is still under debate. Therefore, the aim of this study was to systematically evaluate the efficacy of hyaluronic acid gel in preventing the recurrence of intrauterine adhesion after hysteroscopic adhesiolysis. The Cochrane Library, Embase, and PubMed databases were used to search for articles published before July 31, 2018, using the following terms: hyaluronic acid, intrauterine adhesions, Asherman's syndrome, IUA, hysteroscopy, and hysteroscopic adhesiolysis. Studies on therapies after hysteroscopic adhesiolysis were collected. The recurrence rate of and pregnancy rate in the presence of intrauterine adhesion after hysteroscopic adhesiolysis were analyzed by RevMan 5.3 software. A total of 6 articles were selected, which included 394 patients who were subjected to hysteroscopic adhesiolysis. The meta-analysis results showed that (1) no statistically significant difference was found between hyaluronic acid gel use and without its use on the score of intrauterine adhesion after hysteroscopic adhesiolysis [the mean difference (MD) = ?0.89, 95% confidence interval (CI) (?2.53–0.76), P = 0.29], neither a statistically significant difference was observed between the same groups on the recurrence rate of intrauterine adhesion [odds ratio (OR) = 0.75, 95% CI (0.31–1.81), P = 0.53]; (2) subgroup analysis showed that hyaluronic acid gel could reduce the rate of intrauterine adhesion recurrence in randomized controlled trials [OR = ?0.28, 95% CI (0.14–0.56), P = 0.0006]. However, the recurrence rate of intrauterine adhesion after the use of hyaluronic acid gel was not statistically significant in non-randomized controlled experiments [OR = 1.53, 95% CI (0.79–2.95), P = 0.21]; (3) hyaluronic acid gel did not result in a significant effect on pregnancy rate after intrauterine adhesion separation [OR = 2.02, 95% CI (0.53–7.66), P = 0.3]. In conclusion, hyaluronic acid gel could reduce the recurrence rate of intrauterine adhesion, but had no significant effect on the postoperative pregnancy rate.     

Factors That Impact Fertility after Hysteroscopic Adhesiolysis for Intrauterine Adhesions and Amenorrhea: A Retrospective Cohort Study

Study ObjectiveTo identify factors that affect reproductive outcomes after hysteroscopic adhesiolysis in patients with severe intrauterine adhesions (IUAs, scored between 9 and 12 according to the American Fertility Society classification) and amenorrhea.DesignA retrospective cohort study.SettingA university-affiliated hospital.PatientsOne hundred fifty-one patients with severe IUAs and amenorrhea.InterventionPatients were diagnosed via hysteroscopy and underwent at least 1 hysteroscopic adhesiolysis between May 2012 and January 2016.Measurements and Main ResultsOf 151 patients, 12 were lost to follow-up, and 139 were included in the study with a follow-up period ranging from 2 to 6 years. Of the 139 evaluable patients, 107 (77%) recovered with a normal uterine cavity (free of IUAs), 28 (20.1%) had improved uterine cavity (fewer IUAs), and 4 (2.9%) showed no improvement. Moreover, 79 patients (56.8%) recovered with normal menstruation, 54 (38.9%) showed increased frequency of menstruation, and 6 (4.3%) had persistent amenorrhea. Seventy-seven (55.4%) became pregnant, of whom 13 had a spontaneous miscarriage, 11 birthed prematurely (at 31–36 gestational weeks), 44 experienced term delivery, and 9 were still pregnant at the end of the study. Age >32 years (p = .002, odds ratio [OR] = 3.442), >2 surgeries (p = .027, OR = 2.969), cervical canal adhesions (p = .047, OR = 2.112), and disease course >6 months (p = .037, OR = 2.335) were risk factors for infertility in patients with severe IUAs and amenorrhea.ConclusionYounger age, earlier treatment within the disease course, fewer cervical canal adhesions, and fewer surgical procedures improve the reproductive outcome in patients with severe IUAs and amenorrhea.     

羊膜宫腔内植入+人工周期治疗中、重度宫腔粘连的安全性及有效性

目的:评价人羊膜在宫腔粘连松解术(TCRA)后置入宫腔的安全性及预付再粘连的有效性。方法:回顾性分析34例宫腔中、重度粘连的不孕患者宫腔粘连松解术后宫腔内放置表面被覆羊膜的Foley’s球囊,1周后取出,同时给予雌激素/黄体酮周期治疗。术后第1、3个月宫腔镜检查。随访观察粘连复发率,月经改善和妊娠结局。结果:12例中度粘连组(A组)和22例重度粘连组(B组)患者手术均顺利且无并发症发生,围手术期均无感染症状。A组中75%的患者和B组中45.5%的患者月经恢复正常或得到明显改善。A组无一例宫腔粘连复发,B组中11例复发。所有患者宫内妊娠率为35.3%(12/34)。结论:人羊膜+雌激素/黄体酮周期治疗安全、有效,并能预防宫腔再次粘连的有效方法。     

Predisposing Factors and Treatment Outcome of Different Stages of Intrauterine Adhesions

ObjectiveTo evaluate the predisposing factors and treatment outcomes of different stages of intrauterine adhesions.MethodsWe examined the medical records of women with Asherman syndrome seen during the period of January 2000 to December 2007 at two McGill University teaching hospitals in Montreal. Data retrieved included patient’s age, menstrual pattern, fertility, factors related to intrauterine adhesions, and rates of amenorrhea and pregnancy at 12-month follow-up. The diagnosis was established by hysteroscopic examination. After confirmation of the diagnosis, the intrauterine adhesions were removed using a standard technique with a loop electrode and glycine 1.5% as distension medium. In cases with severe intrauterine adhesions, abdominal ultrasound was used to ensure that the uterine cavity was not breached. At the completion of each procedure a number 16 Foley catheter with 5 mL of normal saline in the bulb was placed in the uterine cavity and removed five days later. In addition, vaginal estradiol 17β was administered three times daily for four weeks with oral progesterone administered in the fourth week of estradiol treatment.ResultsOf 65 patients, we identified 24 with stage I intrauterine adhesions (36.9%), 30 with stage II (46.2%), and 11 with stage III (16.9%). The main reasons for referral were infertility (stage I 75%, stage II 73.3%, stage III 27.3%), and amenorrhea (stage I 25%, stage II 23.3%, stage III 72.7%). The main predisposing factor was dilatation and curettage. Of 40 patients with intrauterine adhesions related to early pregnancy curettage, 18 patients (45%) had stage I adhesions, 17 (42.5%) had stage II, and five (12.5%) had stage III. This contrasted with 10 patients who had peripartum curettage, in whom six (60%) developed stage III adhesions (P = 0.004). The rate of amenorrhea was 32.3% before adhesiolysis and 9.2% after. Among 43 women who wished to conceive, the pregnancy rate was 51.2% and the live birth rate 32.6%.ConclusionThe main reasons for referral of women with intrauterine adhesions are infertility and amenorrhea. Postpartum curettage leads to severe adhesions. The rates of pregnancy and term pregnancy among this selected group of women were similar regardless of the severity of adhesions.     

Amnion graft following hysteroscopic lysis of intrauterine adhesions

AIM: To evaluate the safety and efficacy of amnion grafting after hysteroscopic lysis of intrauterine adhesions. METHODS: In a pilot study involving 25 patients with moderate or severe intrauterine adhesions, hysteroscopic adhesiolysis was followed by intrauterine application of a fresh amnion graft over an inflated balloon of a Foley's catheter for 2 weeks. Follow-up hysteroscopy was performed after 4 months. Outcome measures included recurrence of adhesions, achievement of normal menstrual flow, and improvement in the uterine length. RESULTS: Moderate (group A) and severe (group B) adhesions were found in 12 and 13 subjects, respectively. Uterine perforation occurred in two patients in group B, one treated conservatively and the other via laparoscopy. No clinical evidence of infection was observed, and spontaneous expulsion of the balloon occurred within days in three patients, with easy removal after 2 weeks in the rest of the subjects. Significant improvement in uterine length was found in both groups. Despite improvement, failure to achieve normal menstrual flow was found in 16.7% in group A versus 23.1% in group B. Follow-up hysteroscopy revealed adhesion reformation in 48%, all belonging to group B, all with minimal adhesions. Moderate adhesions were found in only two subjects with previous tuberculous endometritis. CONCLUSION: Hysteroscopic lysis of intrauterine adhesions with amnion grafting seems to be a promising procedure for decreasing recurrence of adhesions and encouraging endometrial regeneration. Randomized comparative studies are needed to validate its benefits, including reproductive outcome.     

妇科腹腔镜手术中转开腹53例多因素分析

目的 探讨妇科腹腔镜手术中转开腹的影响因素。方法 回顾性分析我院2009年9月至2013年9月2890例妇科腹腔镜手术中53例中转开腹的临床资料,并采用多元logistic回归分析妇科腹腔镜手术中转开腹的原因。结果  中转开腹53例,中转开腹率1.83%,中转开腹的原因：未预计的特殊部位子宫肌瘤13例(24.53％),严重盆腹腔粘连19例(35.85％), 止血困难4例(7.55％)。卵巢恶性肿瘤（包括盆腔巨大肿块）14例(26.42％),手术损伤（血管或输尿管）3例(5.66％)。腹腔镜中转开腹的影响因素为腹部手术史（OR 3.076,95％CI 2.457～3.276）、盆腔粘连程度（OR 3.909,95％CI 2.858～4.226）、术中出血（OR 3.491,95％CI 2.778～3.576）、疾病类型（OR 1.869,95％CI 1.243～2.263）和手术方式（OR 1.906,95％CI 1.321～2.211）,患者年龄与中转开腹无关。结论  手术医师腹腔镜手术操作能力,手术前加强病情的评估能够减少术中转开腹率,而及时中转开腹恰恰能够减少手术并发症的发生。      

A Randomized,Multi-Center,Clinical Trial to Assess the Efficacy and Safety of Alginate Carboxymethylcellulose Hyaluronic Acid Compared to Carboxymethylcellulose Hyaluronic Acid to Prevent Postoperative Intrauterine Adhesion

Study ObjectiveTo estimate the efficacy of alginate carboxymethylcellulose hyaluronic acid (ACH) gel to prevent intrauterine adhesions after hysteroscopic surgery in comparison with carboxymethylcellulose hyaluronic acid (CH) gel, which is known as an effective adhesion inhibitor.DesignRandomized, multicenter, single-blind, clinical trial (Canadian Task Force classification I).SettingTertiary university hospital.PatientsOne hundred eighty-seven patients with a surgically treatable intrauterine lesion (myomas, polyps, septa, intrauterine adhesion, dysfunctional uterine bleeding).InterventionsPatients were randomized to 2 groups: hysteroscopic surgery plus intrauterine application of ACH or CH.Measurements and ResultsThe rate of adhesion formation and the adhesion severity score with type and extent were calculated 4 weeks after surgery. The ACH group had results that were comparable to the CH group in terms of the development of intrauterine adhesions at 4 weeks follow-up. The adhesion severities were not different between the 2 groups. In a subgroup without baseline intrauterine adhesion, the ACH group showed a lower intrauterine adhesion rate than the CH group (p = .016).ConclusionsACH had a comparable efficacy to CH in terms of the adhesion rate and severity. In the case of no baseline intrauterine adhesion, intrauterine application of ACH after hysteroscopic surgery had a lower rate of intrauterine adhesion than application of CH.     

卵巢子宫内膜异位囊肿粘连程度及相关因素分析

目的 探讨卵巢子宫内膜异位囊肿(内异症囊肿)粘连程度与患者的临床特点、手术情况及术后复发的关系.方法 对2003年1月至2008年3月就诊于北京协和医院并进行了腹腔镜手术的662例卵巢内异症囊肿患者的临床资料及手术情况进行分析,按术中所见卵巢内异症囊肿与周围组织的粘连情况分为无粘连组31例,轻度粘连(卵巢周围膜状透明粘连,可钝性分离,无血管)组123例,中度粘连(卵巢内异症囊肿被包裹的范围＜1/2,粘连致密,需锐性分离,或者卵巢内异症囊肿被包裹的范围＞1/2,周围疏松粘连,可钝性分离)组310例,重度粘连(卵巢内异症囊肿被包裹的范围＞1/2,多累及卵巢周围脏器和组织,并且粘连致密,需锐性分离,可见血管生成)组198例.比较各组患者疼痛程度、疼痛性质、疼痛时间等临床特点及实验室检查结果、手术情况和术后复发情况,并进行相关危险度和多因素分析.结果 (1)临床特点:中、重度粘连组患者痛经、性交痛、肛门坠胀感、慢性盆腔痛以及CA125异常(>35 kU/L)比例较无粘连、轻度粘连组高,差异有统计学意义(P=0.000、0.000、0.001、0.006、0.000);重度粘连组中不孕患者占15.7%(31/198),高于无粘连组的3.2%(1/31)、轻度粘连组的11.4%(14/123)和中度粘连组的9.7%(30/310),分别比较,差异均有统计学意义(OR=1.728,P<0.05).(2)手术时间及出血量:手术时间无粘连组为(37±15)min,轻度粘连组为(42±19)min,中度粘连组为(50±20)min,重度粘连组为(63±22)min;术中出血量无粘连组为(23±12)ml,轻度粘连组为(31±27)ml,中度粘连组为(40±32)ml,重度粘连组为(70±67)ml.(3)合并其他部位内异症及腺肌病:中、重度粘连组患者中合并子宫腺肌病和(或)深部浸润型内异症患者比例更高(OR=3.466,P=0.000).(4)术后复发:我们将术后复发分为痛经复发和囊肿复发,粘连程度与卵巢内异症囊肿术后复发无明显相关性,但痛经的复发与粘连程度有关(OR=1.685,P=0.046).结论 卵巢内异症囊肿粘连程度越重,疼痛症状越明显,手术时间越长,出血量越多;中、重度粘连患者术后疼痛症状复发率高;粘连程度与囊肿复发率无关.     

子痫前期患者胎盘早剥发病危险因素分析

目的 探讨子痫前期患者胎盘早剥发病的危险因素.方法 对1994年1月至2008年12月的15年间,在北京大学第三医院住院并分娩的219例患者的临床资料进行回顾性分析,根据病情分为3组:子痫前期早剥组,52例,为重度子痫前期发生胎盘早剥的患者;子痫前期组,130例,为重度子痫前期未发生胎盘早剥的患者;原因不明早剥组,37例,为非子痫前期发生胎盘早剥的患者.选择同期无并发症的正常分娩产妇178例为对照组(按1∶2病例对照研究方法选择).采用单因素及多因素回归分析方法,分析子痫前期患者胎盘早剥的发病危险因素.结果 (1)与对照组比较,单因素分析结果显示,孕次、产次、子痫前期病史、中晚期妊娠丢失史、自身免疫性疾病史、慢性高血压病史、此次孕期无规律产前检查、胎儿生长受限(FGR)及脐动脉收缩期最大血流速度(S)与舒张末期血流速度(D)的比值(S/D)异常是子痫前期患者胎盘早剥发病的危险因素;多因素回归分析显示,孕期无规律产前检查(OR=45.348,95%CI为17.096～120.288,P=0.000)、FGR(OR=27.087,95%CI为5.585～131.363,P=0.000)及中晚期妊娠丢失史(OR=16.068,95% CI为1.698～152.029,P=0.015)是子痫前期患者胎盘早剥发病的独立危险因素.(2)与子痫前期组比较,子痫前期病史(OR=3.715,95% CI为1.096～12.596,P=0.035)及孕期无规律产前检查(OR=2.509,95%CI为1.173～5.370,P=0.018)是子痫前期患者胎盘早剥发病的独立危险因素.结论 孕期无规律产前检查、子痫前期病史、中晚期妊娠丢失史及FGR是影响子痫前期患者胎盘早剥发病的危险因素.     

Maternal complications and perinatal outcomes associated with gestational hypertension and severe preeclampsia in Taiwanese women.

BACKGROUND/PURPOSE: The role of proteinuria in disease severity of preeclampsia and gestational hypertension has not been determined. The objective of this study was to compare the effects of disease severity on maternal complications and pregnancy outcome between women with severe preeclampsia and women with gestational hypertension. METHODS: A retrospective case-control study using daily records from the birth registry for the years 1994 to 2003 was conducted. Cases (n = 364) were defined as women with severe preeclampsia. Controls (n = 249) were selected from women with gestational hypertension. The outcome measures were maternal complications and perinatal-related factors. RESULTS: Women with severe preeclampsia had an increased risk of intrauterine growth restriction (adjusted odds ratio [aOR], 2.16; 95% confidence interval [CI], 1.10-4.24; p = 0.026). Risk factors associated with severe preeclampsia patients were lack of prenatal care (aOR, 2.95; 95% CI, 1.45-5.99), systolic blood pressure >or= 180 mmHg (aOR, 14.3; 95% CI, 1.69-121.0), and diastolic blood pressure >or= 105mmHg (aOR, 21.2; 95% CI, 6.99-64.3) compared with women with gestational hypertension in Model I. When we added proteinuria as a variable, two significant risk factors, diastolic blood pressure >or= 105mmHg (aOR, 18.2; 95% CI, 4.85-68.3) and significant proteinuria (aOR, 1.01; 95% CI, 1.006-1.014), were associated with severe preeclampsia patients in Model II. A subgroup of women with gestational hypertension and proteinuria had an increased risk of placental abruption (unadjusted OR, 4.36; 95% CI, 1.05-18.1) and disseminated intravascular coagulation (unadjusted OR, 6.46; 95% CI, 1.05-39.8). Finally, maternal complications (aOR, 2.59; 95% CI, 1.34-5.04) became the single significant factor associated with gestational hypertension and proteinuria. CONCLUSION: Proteinuria may play a role in the progression of gestational hypertension to severe forms of preeclampsia associated with subsequent maternal complications and extremely-low-birth-weight babies.