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1.
早发型重度子痫前期期待治疗时间及妊娠结局 总被引:5,自引:0,他引:5
目的 探讨早发型重度子痫前期期待治疗时间及其妊娠结局.方法 回顾性分析1998年1月至2008年1月,西安交通大学医学院第一附属医院收治的106例早发型重度子痫前期(≤32周)病例,按入院后期待治疗时间分为3组,A组(35例)治疗时间≤48h;B组(36例)治疗时间7~10d;C组(35例)治疗时间≥14d.比较不同期待治疗时间与妊娠结局的关系,包括围生儿结局及严重并发症发生情况.结果 (1)围生儿死亡情况:A组早产儿死亡6例(17.14%),B组2例(5.56%),C组2例(5.71%).A组早产儿病死率明显高于B、C组(P<0.01).(2)并发症发生率依次为胎盘早剥、肾功能衰竭、子痫.A、B、C 3组胎盘早剥发生率分别为:8.57%、8.33%及20%,肾功能衰竭及子痫发生率分别为:5.71%、5.56%及8.57%,上述指标C组均高于A、B组(P<0.05).结论 早发型重度子痫前期严密监测下期待治疗7~10d可明显降低围生儿死亡率,改善围生儿结局,而孕产妇并发症的发生率无明显增加. 相似文献
2.
早发型重度子痫前期与产后出血 总被引:3,自引:0,他引:3
文章介绍了早发型重度子痫前期发生产后出血的临床常见原因为子宫收缩乏力及凝血功能障碍.其治疗除一般复苏及静脉应用缩宫素外,可应用B-Lynch缝合、Hayman子宫压缩缝合等手术疗法及动脉栓塞治疗.并指出低分子肝素可预防产后出血发生. 相似文献
3.
早发型重度子痫前期的期待治疗 总被引:12,自引:0,他引:12
如何选择病例和如何实施期待治疗是早发型重度子痫前期保守处理的关键.应选择无严重并发症和病情稳定的病例在三级医院监管,其治疗措施包括医患间的良好沟通、母胎状况的严密监测、抗高血压和硫酸镁预防性抗痉药的应用,及时终止妊娠和个体化处理原则可以降低母儿的死亡率. 相似文献
4.
早发型重度子痫前期临床处理与母儿结局分析 总被引:1,自引:0,他引:1
目的:探讨早发型重度子痫前期的临床处理及对母儿预后的影响.方法:回顾分析我院2007年1月至2010年12月收治的64例早发型重度子痫前期患者的临床资料.按终止孕周分为3组,A组:28周-31+6周16例,B组:32周~33+6周24例,C组:≥34周24例.结果:A、B、C3组并发症的发生率以A组最低,但3组间比较差异无统计学意义(P>0.05);3组平均期待时间以C组最长,3组之间比较差异均有统计学意义(P<0.05,P<0.01);新生儿死亡率A组与C组比较差异有统计学意义(P<0.05),围生儿死亡率A组与B组、C组比较差异均有统计学意义(P<0.05).结论:早发型重度子痫前期患者终止妊娠前期待治疗是安全有效的,但需密切监测母胎病情变化,掌握终止妊娠时机极为重要,适当的期待治疗有助于改善母婴结局. 相似文献
5.
妊娠期高血压疾病是妊娠期常见的特发性疾病,重度子痫前期是孕产妇及围产儿死亡的重要原因。有学者将在32孕周前发病的重度子痫前期称为早发型,然而更多的学者将于34孕周前发病的重度子痫前期称为早发型[1]。早发型重度子痫前期临床上处理非常棘手。现对我院1997年8月至2006年10月收治的早发型重度子痫前期患者的临床资料作一回顾分析,重点探讨不同孕周的早发型重度子痫前期期待治疗对母儿结局的影响。1资料与方法1.1一般资料1997年8月至2006年10月在我院妇产科分娩总共18 829例,其中重度子痫前期175例,发病率0.93%。诊断标准参照高等院校统… 相似文献
6.
早发型重度子痫前期发病率约为0.3%,部分妊娠24~27周的孕妇可以在密切监护下进行期待治疗,指征如下:(1)一过性实验室检查异常。(2)单纯的尿蛋白异常。(3)单纯的胎儿生长受限。(4)单纯的血压异常。 相似文献
7.
早发型重度子痫前期的研究进展 总被引:1,自引:0,他引:1
早发型重度子痫前期由于其发病早,病情重;较多的并发症;多器官功能同时受损;距离足月较远,使临床处理较为棘手。近年来众多学者提出了期待治疗方法。期待治疗是在严格选择病例的前提下,密切监测母婴病情变化,兼顾母儿利益的同时尽量延长孕周,并适时终止妊娠。现将早发型重度子痫前期发病机制、临床特点、期待治疗对象的选择及治疗方法做一综述。 相似文献
8.
早发型重度子痫前期妊娠结局分析 总被引:11,自引:0,他引:11
目的:探讨早发型重度子痫前期的临床特点及围生结局。方法:回顾性分析2006年6月至2009年6月四川大学华西第二医院收治的重度子痫前期患者413例,以发病孕周34周为界限,分为早发型重度子痫前期组156例(早发型组)及晚发型重度子痫前期组257例(晚发型组)。比较两组一般情况、并发症、分娩方式及围生儿结局等指标。结果:早发型组患者在终止妊娠孕周、延长孕周时间、住院时间、入院时血压、24小时尿蛋白、并发症发生率及围生儿结局等方面与晚发型组比较,差异均有高度统计学意义(P<0.01)。结论:早发型重度子痫前期患者病情严重,围生儿预后不佳,应根据母胎情况,适时剖宫产终止妊娠。 相似文献
9.
《现代妇产科进展》2015,(3)
目的:探讨单纯早发型重度子痫前期(SPE)患者与慢性高血压并发早发型SPE患者的期待治疗时间及妊娠结局的差异。方法:选取2011年6月1日~2014年2月30日于石家庄市第四医院产科诊治并分娩的单胎早发型SPE孕妇350例,其中慢性高血压并发早发型SPE患者60例(A)组,单纯早发型SPE患者290例(B组)。比较两组孕妇的期待治疗时间及母儿结局。结果:慢性高血压并发早发型SPE患者的最高收缩压和舒张压及胎儿生长受限发生率均明显高于单纯早发型SPE患者,期待治疗时间明显长于单纯早发型SPE患者,低蛋白血症及肺水肿发生率低于单纯早发型SPE患者,差异均有统计学意义(P<0.05)。两组孕妇的胎盘早剥、HELLP综合征和子痫等发生率、围产儿死亡率、新生儿死亡、胎死宫内、新生儿窒息的发生率比较,差异无统计学意义(P>0.05)。结论:慢性高血压并发早发型SPE患者较单纯早发型SPE的期待治疗时间长,在病情允许的情况下,通过严密监测母儿一般状况,可适当延长孕周,降低围产儿死亡率。 相似文献
10.
探讨早发型重度子痫前期期待治疗的必要性、可行性和治疗方法的选择.早发型重度子痫前期已引起围产医学界的极大重视,其治疗方法也更趋向于完善和安全.目前主要的治疗方法包括解痉、降压、扩容和适时终止妊娠等.通过已有研究结果,比较各种治疗方法的适应证、具体用药方法及其利弊. 相似文献
11.
Hall DR Odendaal HJ Kirsten GF Smith J Grové D 《BJOG : an international journal of obstetrics and gynaecology》2000,107(10):1258-1264
Objective To evaluate the perinatal outcome of expectant management of early onset, severe pre-eclampsia.
Design Prospective case series extending over a five-year period.
Setting Tertiary referral centre.
Population All women ( n = 340 ) presenting with early onset, severe pre-eclampsia, where both mother and the fetus were otherwise stable.
Methods Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Fetal surveillance included six-hourly heart rate monitoring, weekly Doppler and ultrasound evaluation of the fetus every two weeks. All examinations were carried out in a high care obstetric ward.
Main outcome measures Prolongation of gestation, perinatal mortality rate, neonatal survival and major complications.
Results A mean of 11 days were gained by expectant management. The perinatal mortality rate was 24/1000 (≥ 1000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestational age at delivery to be significantly associated with neonatal outcome. Chief contributors to neonatal mortality and morbidity were pulmonary complications and sepsis. Three pregnancies (0.8%) were terminated prior to viability and only two (0.5%) intrauterine deaths occurred, both due to placental abruption. Most women (81.5%) were delivered by caesarean section with fetal distress the most common reason for delivery. Neonatal intensive care was necessary in 40.7% of cases, with these babies staying a median of six days in intensive care.
Conclusion Expectant management of early onset, severe pre-eclampsia and careful neonatal care led to high perinatal and neonatal survival rates. It also allowed the judicious use of neonatal intensive care facilities. Neonatal sepsis remains a cause for concern. 相似文献
Design Prospective case series extending over a five-year period.
Setting Tertiary referral centre.
Population All women ( n = 340 ) presenting with early onset, severe pre-eclampsia, where both mother and the fetus were otherwise stable.
Methods Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Fetal surveillance included six-hourly heart rate monitoring, weekly Doppler and ultrasound evaluation of the fetus every two weeks. All examinations were carried out in a high care obstetric ward.
Main outcome measures Prolongation of gestation, perinatal mortality rate, neonatal survival and major complications.
Results A mean of 11 days were gained by expectant management. The perinatal mortality rate was 24/1000 (≥ 1000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestational age at delivery to be significantly associated with neonatal outcome. Chief contributors to neonatal mortality and morbidity were pulmonary complications and sepsis. Three pregnancies (0.8%) were terminated prior to viability and only two (0.5%) intrauterine deaths occurred, both due to placental abruption. Most women (81.5%) were delivered by caesarean section with fetal distress the most common reason for delivery. Neonatal intensive care was necessary in 40.7% of cases, with these babies staying a median of six days in intensive care.
Conclusion Expectant management of early onset, severe pre-eclampsia and careful neonatal care led to high perinatal and neonatal survival rates. It also allowed the judicious use of neonatal intensive care facilities. Neonatal sepsis remains a cause for concern. 相似文献
12.
早发型重度子痫前期的基因遗传学研究 总被引:1,自引:0,他引:1
早发型重度子痫前期(EOSP)相关遗传基因的研究,涉及到血管活性物质失衡和血管内皮损害、凝血和纤溶失调、免疫等,这些基因的变异及其多态性与EOSP发病相关.易感基因的发现,不仅可以用于对EOSP易感孕妇的早期筛选、早期诊断,而且可以指导研究者发现新的功能未知的蛋白,寻找EOSP的确切病因. 相似文献
13.
Hall DR Odendaal HJ Steyn DW Grové D 《BJOG : an international journal of obstetrics and gynaecology》2000,107(10):1252-1257
Objective To evaluate the safety and outcome of women undergoing expectant management of early onset, severe pre-eclampsia.
Design Prospective case series extending over a five-year period.
Setting Tygerberg Hospital, a tertiary referral centre.
Population All women ( n = 340 ) presenting with early onset, severe pre-eclampsia, where both the mother and the fetus were otherwise stable.
Methods Frequent clinical and biochemical monitoring of maternal status, together with careful blood pressure control, in a high care obstetric ward.
Main outcome measures Major maternal complications and prolongation of gestation.
Results Multigravid women constituted 67% of the group. Antenatal biochemistry was reassuring with some expected, but not severe, deteriorations. Twenty-seven percent of women experienced a major complication, but few had poor outcomes. No maternal deaths occurred. Most major complications resolved quickly, necessitating only three admissions (0.8%) to the intensive care unit. One woman required dialysis. Pregnancies were prolonged by a mean (median) number of 11 days (9) before delivery, with more time being gained at earlier gestations. The postpartum inpatient stay (89%≤ 7 days, bearing in mind that 82% of women were delivered by caesarean section) was not extended.
Conclusion Careful noninvasive management of early onset, severe pre-eclampsia in a tertiary centre can diminish and limit the impact of serious maternal complications. Valuable time to prolong the pregnancy and improve neonatal outcome is thereby gained. 相似文献
Design Prospective case series extending over a five-year period.
Setting Tygerberg Hospital, a tertiary referral centre.
Population All women ( n = 340 ) presenting with early onset, severe pre-eclampsia, where both the mother and the fetus were otherwise stable.
Methods Frequent clinical and biochemical monitoring of maternal status, together with careful blood pressure control, in a high care obstetric ward.
Main outcome measures Major maternal complications and prolongation of gestation.
Results Multigravid women constituted 67% of the group. Antenatal biochemistry was reassuring with some expected, but not severe, deteriorations. Twenty-seven percent of women experienced a major complication, but few had poor outcomes. No maternal deaths occurred. Most major complications resolved quickly, necessitating only three admissions (0.8%) to the intensive care unit. One woman required dialysis. Pregnancies were prolonged by a mean (median) number of 11 days (9) before delivery, with more time being gained at earlier gestations. The postpartum inpatient stay (89%≤ 7 days, bearing in mind that 82% of women were delivered by caesarean section) was not extended.
Conclusion Careful noninvasive management of early onset, severe pre-eclampsia in a tertiary centre can diminish and limit the impact of serious maternal complications. Valuable time to prolong the pregnancy and improve neonatal outcome is thereby gained. 相似文献
14.
早发型重度子痫前期凝血功能变化及抗凝治疗 总被引:2,自引:0,他引:2
文章阐述了早发型重度子痫前期的凝血功能变化及机制,提出抗凝治疗可能是一种有前景的治疗方法,包括小剂量阿司匹林、低分子肝素、抗凝血酶Ⅲ等的使用;也包括中药,如丹参的使用. 相似文献
15.
目的探讨早发型和晚发型重度子痫前期分娩方式及母婴结局。方法收集1977-2010年在西安交通大学医学院第一附属医院产科住院的重度子痫前期患者4457例,其中早发型860例,晚发型3597例。回顾性分析其分娩方式及母婴结局。结果早发型和晚发型重度子痫前期剖宫产率分别为57.7%和36.9%,早发型明显高于晚发型(P=0.02);胎盘早剥是最常见并发症,在早发型和晚发型重度子痫前期发生率分别为6.7%和4.6%(P<0.05)。早发型和晚发型重度子痫前期围生儿死亡率分别为3.6%和2.2%(P<0.01)。特别是早发型妊娠34周前终止妊娠者,围生儿死亡率高达4.9%。结论子痫前期终止妊娠的主要方式为剖宫产术;发病孕周越早,母婴不良结局发生率越高。 相似文献
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17.
早发型重度先兆子痫的临床界定及保守治疗探讨 总被引:136,自引:1,他引:136
目的 探讨早发型重度先兆子痫的临床界定及保守治疗的临床意义。方法 回顾分析1988年9月至2004年4月,北京大学第三医院收治的255例无严重并发症及合并症的重度先兆子痫患者的临床资料,按重度先兆子痫发病孕周分为4组:A组<28周, 24例; B组28~31周, 50例;C组32~33周, 34例;D组≥34周, 147例。主要分析指标包括:发病孕周、终止妊娠孕周、孕周延长时间、严重并发症发生情况、胎儿及新生儿死亡率和小于孕龄儿发生率。结果 (1)A组保守治疗时间平均为(9 ±8)d,B组为(11±8)d,C组为(8±6)d,D组为(5±4)d,D组保守治疗时间与前3组比较, 差异有统计学意义(P<0 .01 )。而A、B、C各组间的保守治疗时间比较,差异无统计学意义(P>0. 05)。A、B、C各组孕妇并发症发生率比较,差异也无统计学意义(P>0 .05 ),但与D组比较,差异有统计学意义(P<0 .01);A、B组胎儿及新生儿死亡率、胎死宫内发生率与C、D组比较,差异均有统计学意义(P<0 .01),而C、D两组间比较,差异无统计学意义(P>0 .05)。(2)多因素logistic回归分析显示,重度先兆子痫发病孕周,是影响孕妇并发症发生率的重要因素,而与保守治疗时间无相关性。终止妊娠孕周是影响胎儿及新生儿死亡率的主要因素,其次为发病孕周。(3)以32孕周为界值进行多因素分析显示,终止妊娠孕周 相似文献
18.
Delivery of patients with early onset, severe pre-eclampsia. 总被引:5,自引:0,他引:5
D R Hall H J Odendaal D W Steyn 《International journal of gynaecology and obstetrics》2001,74(2):143-150
OBJECTIVES: To compare the effects of induction/labor to delivery before labor in early onset, severe pre-eclampsia. METHODS: Five-year prospective case series. Delivery course and neonatal outcome were examined for 335 women with viable singletons. RESULTS: Induction was successful in 45% of attempts. Women exposed to labor had longer (5.5 days, P<0.0001) admissions to delivery periods and were more often delivered for maternal indications (RR=2.87, 95% CI=1.98-4.16). Their babies were born 1.6 weeks older (P<0.0001) and 352 g heavier (P<0.0001) than those delivered before labor. Babies exposed to labor needed intensive care less often (RR=0.4, 95% CI=0.27-0.58), had lower rates of severe hyaline membrane disease (RR=0.26, 95% CI=0.11-0.59) and sepsis (RR=0.56, 95% CI=0.33-0.93), and were discharged earlier (P<0.0001). CONCLUSIONS: Exposure to induction/labor in selected patients is not detrimental to neonatal outcome in early, severe pre-eclampsia. 相似文献