125例妊娠并发弥散性血管内凝血原发病因与预后分析

目的:探讨妊娠并发弥散性血管内凝血(DIC)患者的原发病因及其预后.方法:对2004年1月至2009年12月我院收治的125例妊娠并发DIC患者的病因及其死亡原因进行回顾性分析.结果:①125例妊娠并发DIC患者主要病因为产后出血49例(39.2％)、胎盘早剥25例(20.0％)、妊娠期急性肝病15例(12.0％)、重度子痫前期或子痫10例(8.0％)、羊水栓塞10例(8.0％).②26例死亡患者引起死亡的主要病因为羊水栓塞(50.0％,5/10)、妊娠期急性肝病(40.0％,6/15),产后出血(16.3％,8/49),胎盘早剥(16.0％,4/25).③不同病因的DIC死亡患者出现功能障碍的器官不一样.结论:妊娠并发DIC原发病因中以产科因素为主;不同原发病因DIC患者死亡率有明显差异,累及的系统或器官不同.提示临床工作中可根据不同原发病因采取相应的预防和治疗措施.     

产科危重患者多器官功能障碍综合征的临床分析

目的 :分析产科危重患者多器官功能障碍综合征 (MODS)的发病特点及诱因 ,以及与急性生理与慢性健康状况评分II(APACHEII)的关系。方法 :回顾分析 2 0 0 0年1月至 2 0 0 4年 4月转入GICU产科危重患者中发生MODS 6 6例的临床资料 ,并计算其A PACHEII评分。结果 :产科MODS患者诱因主要是产科因素 ,共 4 8例 (72 .73% ) ,死亡 7例 (14 .5 8% ) ,以重度子痫前期或子痫及产后出血为主 ;诱因 18例妊娠合并内外科疾病 ,死亡 11例 ,死亡率为 6 1.11% ,以妊娠合并心脏病和妊娠合并重症肝炎为主。产科MODS患者死亡率随着器官损害数的增多而上升 ,差异有显著性 (P <0 .0 5 ) ;随着器官损害数的增多 ,APACHEII评分逐渐升高 ,差异有显著性 (P <0 .0 5 ) ;APACHEII评分用于预测MODS死亡阳性率 ,2 ,3,4 ,5个器官受损害 ,其阳性率分别为 33.4 5 % ,5 7.12 % ,97.0 9% ,10 0 %。结论 :产科多器官功能障碍 /衰竭的产科主要诱因是重度子痫前期 /子痫 ,产后出血 ;产科MODS患者死亡率也随着器官损害数的增多而上升 ;APACHEII评分可在一定程度上作为评定产科MODS患者病情危重程度和预测预后的指标。     

子痫前期-子痫相关问题的讨论

主要讨论内容1.子痫前期-子痫的命名与分类2.子痫前期-子痫病因3.子痫前期-子痫的临床处理4.子痫前期-子痫并发HELLP综合征5.子痫前期-子痫合并急性心力衰竭6.子痫前期-子痫并发脑血管意7.子痫前期-子痫并发急性肾功能衰竭8.子痫前期-子痫并发肺水肿9.胎盘早剥的早期诊断问题10     

产后血浆置换治疗不典型子痫前期—子痫并HELLP综合征

经临床治疗仍不能缓解的不典型子痫前期—子痫并HELLP综合征者,尤其存在其它多器官损伤时,如何选择合适的治疗方案?为此采用产后新鲜冰冻血浆置换法(Plasma exchange, PE)治疗难治性HELLP综合征。 1984年7月～1993年6月,Mississippi大学医疗中心对18例重度子痫前期—子痫并HELLP综合征者进行了产后PE治疗。不并其他器官损害者9例分为1组,同时合并一个或多种器官损害者9例分为2组。使用手提IBM-2997型流式细胞分离仪作床边     

HELLP综合征15例临床分析

目的:通过对HELLP综合征患者的临床经过及死因进行分析,以探讨更好的诊治方法.方法:对我院6年中诊断为HELLP综合征的15例患者的临床经过、实验室检查、并发症和母儿结局进行回顾性分析.结果:15例患者平均发病孕周35.31±3周,完全性HELLP综合征12例(其中2例为产后发展为HELLP),部分性HELLP综合征3例.全部有肝酶升高(45～580U/L)和血小板减少(6～74×109/L).孕产妇并发症:腹水、肾功能衰竭、胎盘早剥、DIC、脑部病变、子痫、产后出血,1例继发血栓性血小板减少性紫癜.15例患者均接受血浆及常规激素治疗,其中2例另接受血浆置换,1例并发急性呼吸窘迫综合征(ARDS).母亲死亡2例(13.33%)(脑疝、ARDS各1例),围生儿死亡4例(26.67%,新生儿死亡、死产各1例,死胎2例).结论:重视重度子痫前期的管理和治疗,早期发现HELLP综合征、大剂量激素应用,24～48小时后终止妊娠,动态观察产后72小时的实验室指标和临床变化,避免过度输液,可望改善母儿预后.     

子痫前期严重并发症的危险因素分析

目的探讨子痫前期患者发生严重并发症的危险因素。 方法回顾性分析805例子痫前期患者及其围产儿临床资料,将发生严重并发症的327例患者作为研究组,478例未发生严重并发症患者作为对照组。 结果(1)子痫前期严重并发症发生率为40.6%(327/805例),327例患者的严重并发症包括138例死胎(42.2%)、71例HELLP综合征(21.7%)、65例胎盘早剥(19.9%)、39例心功能衰竭(11.9%)、39例产后出血(11.9%)、36例肺水肿(11.0%)等。(2)两组患者临床表现进行的比较,发病孕周、收缩压、舒张压、血肌酐、丙氨酸转氨酶、血清白蛋白和期待治疗时间,差异具有统计学意义(P<0.05)。(3)多因素logistic回归分析提示子痫前期严重并发症独立危险因素为：发病孕周早(OR＝0.783,95%CI: 0.745～0.823)、高血肌酐(OR＝1.005,95%CI: 1.001～1.008)、低白蛋白(OR＝0.961,95%CI: 0.929～0.994)。 结论子痫前期严重并发症发生危险因素为发病孕周早、肾功能损害、低蛋白血症。     

子痫前期子痫并发脑血管意外的类型及处理

子痢前期、子痫并发脑血管意外是产科临床严重的并发症，是其死亡的首位原因。我院近10年共收治子痫前期、子痫患者347例，并发脑血管意外3例，其发生率为0．8％。     

单胎妊娠重度子痫前期并发HELLP综合征26例临床分析

目的探讨重度子痫前期并发HELLP综合征对母儿结局的影响。方法 2008年10月至2011年10月北京大学人民医院收治重度子痫前期121例（双胎妊娠12例,单胎109例）,其中重度子痫前期并发HELLP综合征31例（双胎妊娠5例,单胎妊娠26例）,将26例单胎妊娠并发HELLP综合征患者为HELLP组;重度子痫前期未并发HELLP综合征90例（双胎妊娠7例,单胎妊娠83例）,将83例单胎妊娠未并发HELLP综合征患者为对照组。回顾性分析HELLP组和对照组孕妇的母儿结局。结果 HELLP组中最高舒张压、确诊孕周和终止妊娠孕周分别为（109.62±19.23）mm Hg、（32.02±4.50）周和（32.18±4.93）周,对照组分别为（99.14±11.70）mm Hg、（35.25±3.88）周和（35.66±3.69）周,两组比较,差异均有统计学意义（P〈0.05）。HELLP组期待治疗时间（1.38±2.62）d与对照组（2.49±3.46）d比较,差异无统计学意义（P〉0.05）,HELLP组剖宫产率（57.69%,15/26）与对照组（81.93%,68/83）比较,差异有统计学意义（P〈0.05）。两组尿蛋白、使用硫酸镁剂量比较,差异均无统计学意义（P〉0.05）。HELLP组使用静脉降压药物、眼底痉挛渗出、多浆膜腔积液及低氧血症发生率分别为34.62%（9/26）、46.15%（12/26）、65.38%（17/26）和19.23%（5/26）,对照组分别为3.61%（3/83）、13.25%（11/83）、10.84%（9/83）和3.61%（3/83）,两组比较,差异均有统计学意义（P〈0.05）。HELLP组新生儿体质量[（1751.80±1027.13）g]与对照组[（2474.20±946.61）g]比较,差异有统计学意义（P〈0.05）。HELLP组孕产妇死亡1例;死儿丢失11例;对照组未发生孕妇死亡,发生死儿丢失11例。结论重度子痫前期并发HELLP综合征是病情危重的表现,其发病孕周较早,影响胎盘功能可致胎儿发育受限及死胎,严重影响胎儿结局。母体并发多浆膜腔积液及低氧血症比例高于未并发HELLP综合征患者。经积极的救治和处理可争取较好     

足月妊娠期高血压及非重度子痢前期孕妇引产后严重产后出血的危险因素分析

目的:探讨足月妊娠期高血压及非重度子痫前期患者引产中严重产后出血的危险因素。方法:回顾性分析2016年1月1日至2020年12月31日于中国医科大学附属盛京医院住院的足月妊娠期高血压、非重度子痫前期并选择引产终止妊娠的患者370例的临床资料，依据产后血红蛋白(Hb)下降情况(Hb下降40 g/L为严重产后出血)分成严重产后出血组(59例)和非严重产后出血组(311例);使用单因素及多因素分析确定妊娠期高血压及非重度子痫前期引产终止妊娠者严重产后出血的危险因素。结果:(1)5年来足月妊娠期高血压及非重度子痫前期患者中引产及引产后发生严重产后出血的比例基本上呈逐年上升趋势，选择引产终止妊娠者中严重产后出血的发生率为15.95%(59/370)。(2)严重产后出血组中经阴道分娩率、器械助产率、分娩中应用缩宫素率及引产开始到分娩时间均高于非严重产后出血组，差异有统计学意义((印)P(正)<0.05)。(3)Logistic回归分析显示，经阴道分娩((印)OR(正) 5.737,95%CI 2.201～14.956)、器械助产((印)OR(正) 75.627,95%CI 6.140～931.543)及分娩中应用缩宫素((印)OR(正) 2.623,95%CI 1.085～6.342)为严重产后出血的独立危险因素((印)P(正)<0.05)。结论:足月妊娠期高血压及非重度子痫前期患者的引产率逐年上升，应关注严重产后出血的发生，而经阴道分娩、器械助产、缩宫素的使用增加了严重产后出血发生的风险，应早期识别、及时干预。     

全程硬膜外分娩镇痛在重度子痫前期患者阴道分娩中的临床效果观察

目的:探讨持续硬膜外分娩镇痛在重度子痫前期患者阴道分娩中的临床效果。方法:回顾性分析上海市嘉定区妇幼保健院2017年7月至2018年6月期间收治的要求镇痛分娩的妊娠期高血压组孕妇80例,轻度子痫前期组68例,重度子痫前期组40例;另选同期正常孕妇92例作为对照组。采用视觉模拟疼痛评分(VAS),记录镇痛前及镇痛后直至宫口开全、胎儿娩出时的VAS评分及平均动脉压(MAP),同时分析第一产程、第二产程时间、阴道分娩成功率、产后出血发生率的差异,探讨镇痛分娩后母体和胎儿的结局。结果:(1)各研究组经过硬膜外分娩镇痛后VAS评分都显著降低,各组在不同时间段VAS评分相比,差异无统计学意义(P 0. 05)。(2)全程硬膜外分娩镇痛后轻度子痫前期组、重度子痫前期组及妊娠期高血压组的MAP在产程中明显降低,与对照组相比,差异无统计学意义(P 0. 05);(3)全程硬膜外分娩镇痛后重度子痫前期组的第一产程、第二产程时间、阴道分娩成功率与其他3组比较,差异无统计学意义(P 0. 05);(4)重度子痫前期组胎儿窘迫、新生儿窒息、产后出血发生率及新生儿入NICU与其他3组比较,差异无统计学意义(P 0. 05);各组均未发生胎盘早剥、子痫、HELLP综合征、心脑血管意外。全程硬膜外分娩镇痛后对照组缩宫素使用率显著高于其他3组(P 0. 05)。结论:全程硬膜外分娩镇痛能有效缓解重度子痫前期患者的分娩疼痛、维持血压的稳态,且不增加剖宫产率,不影响母儿结局。     

Disseminated intravascular coagulation in the HELLP syndrome: how much do we really know?

The rate of disseminated intravascular coagulation (DIC) during pregnancy varies among nations from 0.03% to 0.35%. The existing reports suggest dissimilarity in the underlying mechanisms leading to DIC during gestation. While in developing countries preeclampsia and the HELLP syndrome are prevalent causes of DIC, the leading causes in the developed countries are placental abruption and postpartum hemorrhage. In different cohort studies, DIC is reported in about 12–14% of women with preeclampsia. Nevertheless, it has been suggested that in most cases these women also had a HELLP syndrome and that the occurrence of DIC in women who had only preeclampsia without manifestations of the HELLP syndrome is rare. The aims of this review are to: (1) highlight the mechanisms leading to DIC; (2) describe the changes in the coagulation system during this complication; and; (3) discuss the diagnostic tool and treatment modalities of DIC, in women who develop a HELLP syndrome.     

Hypothyroidism complicating pregnancy

Hypothyroidism rarely complicates pregnancy because most affected women are anovulatory. In this report, we describe 28 complicated pregnancies cared for over a ten-year period at Parkland Memorial Hospital. In the group of 16 pregnancies in 14 overtly hypothyroid women, maternal complications were common and included anemia (31%), preeclampsia (44%), placental abruption (19%), postpartum hemorrhage (19%), and cardiac dysfunction. Perinatal morbidity and mortality were also high mainly because of placental abruption, and reflected frequent low birth weight (31%) and fetal death (12%). In a group of 12 women with subclinical hypothyroidism, these complications were less impressive. We speculate that overt thyroid deficiency is associated with adverse pregnancy outcome related to preeclampsia and placental abruption. Thyroxine replacement probably improves these outcomes even if subclinical hypothyroidism persists.     

妊娠期高血压疾病严重并发症的发生规律及其对母儿的影响

目的探讨妊娠期高血压疾病严重并发症的发生规律及其对孕产妇和围产儿的影响。方法对1995-2004年南方医科大学南方医院、珠江医院、广州市第二人民医院和广州市番禺区何贤纪念医院共71020例孕妇中的4107例妊娠期高血压疾病患者的临床资料进行回顾性分析。结果（1）妊娠期高血压疾病发生率：为5．78％（4107／71020）,其中重度子痫前期为27．78％（1141／4107）,轻度子痫前期为72．22％（2966／4107）。（2）妊娠期高血压疾病严重并发症发生率：胎盘早剥为1．68％（69／4107）,DIC为1．36％（56／4107）,妊娠期高血压疾病性心脏病为1．05％（43／4107）,肾功能衰竭为0．97％（40／4107）,脑血管意外为0．58％（24／4107）,溶血、肝酶升高、低血小板计数（HELLP）综合征为0．51％（21／4107）。（3）孕产妇死亡：孕产妇均死于多重并发症,死亡率为0．19％（8／4107）,死亡专率为11．26／10万（8／71020）,死亡病例中,脑血管意外4例次（17％,4／24）,HELLP综合征2例次（10％,2／21）,DIC3例次（5％,3／56）,妊娠期高血压疾病性心脏病1例（2％,1／43）。（4）围产儿死亡：围产儿死亡率为3．01％（130／4319）。死亡病例中,孕产妇发生胎盘早剥33例（43％,33／77）,HELLP综合征10例（42％,10／24）,DIC22例（34％,22／64）,肾功能衰竭11例（25％,11／44）,脑血管意外6例（24％,6／25）,妊娠期高血压疾病性心脏病8例（16％,8／49）。结论（1）妊娠期高血压疾病严重并发症的发生率由高到低依次为：胎盘早剥、DIC、妊娠期高血压疾病性心脏病、肾功能衰竭、脑血管意外、HELLP综合征。（2）致孕产妇死亡的并发症依次为：脑血管意外、HELLP综合征、DIC和妊娠期高血压疾病性心脏病。（3）致围产儿死亡的孕妇并发症依次为：胎盘早剥、HELLP综合征、DIC、肾功能衰竭、脑血管意外和妊娠期高血压疾病性心脏病。     

2 486例妊娠期高血压疾病患者的临床分析

目的了解近年来南方医科大学附属深圳妇幼保健院收治的妊娠期高血压疾病患者的发病趋势、并发症情况及对妊娠结局的影响。 方法回顾性分析2009年1月至2013年12月在南方医科大学附属深圳妇幼保健院就诊并分娩的2 486例妊娠期高血压疾病患者的临床资料,包括发病率、孕妇年龄、住院天数、分娩方式、流动人口比例及母婴并发症等。 结果5年间我院重度子痫前期发生率呈现下降趋势,从2009年的1.74%降至2013年的1.34%(χ²＝12.321,P<0.05);流动人口所占比例较高(46.46%);分娩方式仍然以剖宫产为主(74.09%),高于阴道分娩(21.44%),(χ²＝736.084,P<0.001)。妊娠期高血压疾病孕妇严重并发症的构成依次是：产后出血、胎盘早剥、HELLP综合征、心功能不全、弥散性血管内凝血、急性肾衰竭、脑血管意外;其围产儿严重并发症的构成依次为：早产、胎儿生长受限、新生儿窒息、死胎、流产。 结论妊娠期高血压疾病仍是威胁孕产妇以及围产儿健康的严重疾病,必须加强产前保健,早发现、早诊断和早治疗,以改善母婴妊娠结局。     

单、双胎妊娠并发子痫前期不良妊娠结局的荟萃分析

目的探讨单、双胎妊娠并发子痫前期的孕妇与围产儿不良结局发病率差异。 方法检索PubMed、Web of Science、中国生物医学文献数据库、中国学术文献总库、万方和维普中文数据库中2000年1月至2017年12月国内外发表的关于单、双胎妊娠并发子痫前期妊娠结局的研究。采用RevMan 5.3与Stata 12.0软件对资料进行荟萃分析,采用OR值及相应的95%CI评价不良结局与双胎妊娠并发子痫前期的相关性。 结果纳入10篇文献,共692例双胎妊娠合并子痫前期,3101例单胎妊娠合并子痫前期。双胎妊娠合并子痫前期组发病率高于单胎妊娠合并子痫前期：胎盘早剥OR＝2.16,95%CI为1.40～3.36;产后出血OR＝2.90, 95%CI为2.03～4.15;心功能衰竭OR＝3.73, 95%CI为2.10～6.63 ;肺水肿OR＝2.76, 95%CI为1.04～7.27;剖宫产OR＝2.27, 95%CI为1.58～3.26;胎膜早破OR＝2.99, 95%CI为1.64～5.47;早产OR＝6.24,95%CI为4.16～9.38,新生儿重症监护病房转入率OR＝2.33, 95%CI为1.66～3.26。 结论双胎妊娠合并子痫前期的不良妊娠结局包括胎盘早剥、产后出血、心功能衰竭、肺水肿、剖宫产、胎膜早破、早产和新生儿重症监护病房转入的发病率比单胎妊娠合并子痫前期高。     

The incidence of severe complications of preeclampsia.

OBJECTIVES: To examine the incidence of life-threatening (near-miss) complications, including hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome occurring in women with preeclampsia in the Grampian region of Scotland between 1981 and 2000. SUBJECTS AND METHODS: All women who were resident in a geographically determined region (the Grampian region of Scotland) and who developed moderate to severe preeclampsia in the time period 1981 to 2000 were identified from the Aberdeen Maternity and Neonatal Databank. All complications occurring antepartum, intrapartum, or postpartum in these pregnancies were listed as International Classification of Diseases (ICD) codes and significant complications were identified from these. The cases of HELLP syndrome were identified by case note review. Data were analyzed using Statistical Package for Social Scientists (SPSS). RESULTS: A total of 4188 cases of preeclampsia were identified over the 20-year period. Six percent (approx. 1 in 16) of preeclamptics developed one or more major systemic complications. The incidence of placental abruption and eclampsia was 2.8% and 1.65%, respectively. Hematological complications were most common, with reduced platelets accounting for about half of these cases; although, a definite diagnosis of HELLP syndrome could only be made in 13 cases over 20 years. After adjusting for gestational age, a woman was 1.14 times more likely to have a caesarean delivery (95% C.I. 1.08, 1.20) if she had complicated preeclampsia. She was also more likely to have a stillbirth [Odds Ratio (O.R.) = 1.45 (95% C.I. (confidence interval) 1.02, 2.29)] or a neonatal death [O.R. = 2.25 (95% C.I. 1.12, 4.260]. CONCLUSIONS: There has been a gradual decline in the rate of preeclampsia in the Grampian region of Scotland over the time period 1986 to 2000; although, the percentage of pre-eclamptics who developed one or more complications has not decreased appreciably. In fact, the incidence of eclampsia and placental abruption has increased in the most recent five years. The presence of complications in preeclampsia is associated with a poor neonatal outcome.     

妊娠高血压综合征并发溶血、肝酶升高及血小板减少综合征14例临床分析

目的 探讨与分析妊娠高血压综合征（妊高征）并发溶血,肝酶升高及血小板减少综合征（HELLP综合征）的发病率,诊断,治疗及预后。方法 对我院7年来妊高征并发HELLP综合征14例患者的临床资料进行回顾性分析。结果 HELLP综合征在重度妊高征患者中的发病率为8％,参考美国Tennessee大学制定的诊断标准,完全性HELLP综合征8例,部分性HELLP综合征6例。治疗方法对严密监护母儿情况下积极治疗妊高征,早期使用糖皮质激素,尽快终止妊娠。主要并发症为DIC,肝被膜下血肿,胎盘早剥,肺水肿和急性肾功能衰竭等。14例患者中死亡1例,围产儿死亡4例,死亡率分别为7％及29％。结论 HELLP综合征是重度妊高征的一种严重威胁母儿安全的并发症,及早发现并应用糖皮质激素治疗,可以降低母儿死亡率。     

The Incidence of Severe Complications of Preeclampsia

Objectives. To examine the incidence of life-threatening (near-miss) complications, including hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome occurring in women with preeclampsia in the Grampian region of Scotland between 1981 and 2000. Subjects and Methods. All women who were resident in a geographically determined region (the Grampian region of Scotland) and who developed moderate to severe preeclampsia in the time period 1981 to 2000 were identified from the Aberdeen Maternity and Neonatal Databank. All complications occurring antepartum, intrapartum, or postpartum in these pregnancies were listed as International Classification of Diseases (ICD) codes and significant complications were identified from these. The cases of HELLP syndrome were identified by case note review. Data were analyzed using Statistical Package for Social Scientists (SPSS). Results. A total of 4188 cases of preeclampsia were identified over the 20-year period. Six percent (approx. 1 in 16) of preeclamptics developed one or more major systemic complications. The incidence of placental abruption and eclampsia was 2.8% and 1.65%, respectively. Hematological complications were most common, with reduced platelets accounting for about half of these cases; although, a definite diagnosis of HELLP syndrome could only be made in 13 cases over 20 years. After adjusting for gestational age, a woman was 1.14 times more likely to have a caesarean delivery (95% C.I. 1.08, 1.20) if she had complicated preeclampsia. She was also more likely to have a stillbirth [Odds Ratio (O.R.) = 1.45 (95% C.I. (confidence interval) 1.02, 2.29)] or a neonatal death [O.R. = 2.25 (95% C.I. 1.12, 4.260]. Conclusions. There has been a gradual decline in the rate of preeclampsia in the Grampian region of Scotland over the time period 1986 to 2000; although, the percentage of pre-eclamptics who developed one or more complications has not decreased appreciably. In fact, the incidence of eclampsia and placental abruption has increased in the most recent five years. The presence of complications in preeclampsia is associated with a poor neonatal outcome.     

Risk factors for relaparotomy after cesarean section

Objective: To investigate risk factors for relaparotomy after cesarean section (CS). Methods: A retrospective case-control study comparing all CS that were complicated with relaparotomy to cesarean deliveries without this complication. Results: Relaparotomy complicated 0.23% (n?=?80) of CS during the study period (n?=?34,389). Independent risk factors for relaparotomy following CS from a multivariable logistic regression model were post partum hemorrhage, cervical tears, placenta previa, uterine rupture, placental abruption, severe preeclampsia and previous CS. Most women (51.2%) underwent relaparotomy during the first 24?h after CS. The leading causes for relaparotomy was bleeding (70%) and burst abdomen (8.8%). Hysterectomy was performed in 31.3% of the patients. Conclusion: Risk factors for relaparotomy after CS are previous CS, severe preeclampsia, placenta previa, uterine rupture, placental abruption, cervical tear and PPH. Experienced obstetricians should be involved in such cases and the possibility for complications including relaparotomy should be emphasized.