重度子痫前期终止妊娠时机探讨

目的探讨重度子痫前期终止妊娠时机。方法回顾性分析我院2000年1月~2006年3月收治的141例重度子痫前期患者(发病孕周为28~35 6周)的临床资料,按发病孕周将其分成四组28~29 6周、30~31 6周、32~33 6周和34~35 6周,分析实施期待治疗与积极治疗的产科和围产结局。结果①四组的期待治疗平均延长孕龄分别为(5.5±1.8)d、(12.7±6.6)d、(9.7±5.2)d和(7.5±4.1)d,四组间比较,差异有统计学意义(P<0.05);②发病孕周在28~33 6周组的期待治疗者的新生儿窒息率和NICU住院率均低于积极治疗组(P<0.05),期待治疗组的新生儿体重明显大于积极治疗组(P<0.01);而34~35 6周期待治疗组的新生儿窒息率、NICU住院率和新生儿体重与积极治疗组比较差异均无统计学意义(P>0.05);③多因素Logistic回归分析显示在28~33 6周期待治疗可以降低新生儿窒息率且没有加重孕妇脏器损害,而在34~35 6周组期待治疗并未改善母儿结局;④本研究无孕产妇死亡及后遗症发生。结论根据发病孕周不同,对重度子痫前期患者进行恰当的期待治疗,尽可能延长孕周至34周以后终止,有利于改善围生儿结局。     

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     

重度子痫前期并发肠出血坏死及胎盘早剥1例报告

河南省南阳市方城县人民医院收冶1例重度子痫前期并发肠出血坏死及胎盘早剥少见病例。报道如下。患者31岁。孕3产1流产1,因"停经9个月余,血压升高5个月,全身水肿10d,视物模糊伴腹胀2d",于2010-10-19入院。患者平素月经规律,末次月经2010-02-04。早孕期有轻微的早孕反应,孕4个月余发现血压升高(具体数值不详)。无头痛、头晕、视物不清等不适,未诊治。于入院10d前出现下肢水肿,渐向上蔓延至下腹部,伴饮食、     

早发型重度子痫前期胎儿宫内监测及胎儿生长受限的处理

文章介绍了早发型重度子痫前期胎儿宫内监测的指标、方法等内容,并从几方面介绍了早发型重度子痫前期胎儿生长受限的处理,提出期待治疗中要严密监测胎儿的情况,及早发现胎儿生长受限,并给予及时的治疗,可改善围生儿的结局.     

子痫前期并发胎儿生长受限的临床特征及妊娠结局分析

目的 探讨子痫前期并发胎儿生长受限(fetal growth restriction,FGR)的临床特征及母儿结局.方法 回顾性分析2009年1月1日至2019年12月31日在广州医科大学附属第三医院产科就诊并分娩的单胎子痫前期患者的病例资料,根据是否合并FGR,分为FGR组和对照组,分析两组的临床特征及母儿结局.结果...     

早发型重度子痫前期合并胎儿生长受限期待治疗的妊娠结局探讨

目的:探讨期待治疗中早发型重度子痫前期合并胎儿生长受限(FGR)的母儿结局,为临床处理提供依据。方法:回顾性分析2002年1月至2012年12月厦门大学附属第一医院产科收治的早发型重度子痫前期患者143例的临床资料,其中合并FGR 48例(合并FGR组),未合并FGR 95例(未合并FGR组)。比较两组一般情况、孕产妇并发症、分娩情况和新生儿情况及143例患者不同分娩孕周(孕30周、孕30~31+6周、≥孕32周)围生儿结局。结果:1两组一般情况、期待治疗平均延长孕周和孕产妇并发症(HELLP综合征、子痫、胎盘早剥、心衰等)的发生率比较,差异均无统计学意义(P0.05)。2合并FGR组分娩孕周晚于未合并FGR组(P0.05),但其新生儿出生体重小于未合并FGR组(P0.05)。合并FGR组围生儿死亡率高于未合并FGR组(P0.05)。3新生儿并发症中,合并FGR组心脏发育不全的发生率高于未合并FGR组(P0.05)。4随着分娩孕周增加,早发型重度子痫前期患者的围生儿死亡率和新生儿肺透明膜病的发生率逐渐降低,差异均有统计学意义(P0.05)。合并FGR围生儿死亡率和总体心脏发育不全的发生率在分娩孕周≥32周后也明显降低(P0.05)。结论:对于早发型重度子痫前期合并FGR的患者,期待治疗并不增加孕产妇并发症。合并FGR的患儿心脏发育不全发生率及围生儿死亡率明显增加,但期待治疗后通过延长孕周可改善其围生儿结局。     

转甲状腺蛋白在重度子痫前期及胎儿生长受限孕妇血清中的表达及意义

目的:探讨转甲状腺蛋白(TTR)与s PE及FGR发病的关系及意义。方法:选取2012年9月1日至2015年2月1日在首都医科大学附属北京潞河医院产检并住院分娩的单胎孕妇120例,将患者分为4组:FGR组、s PE组、s PE+FGR组和对照组(各30例)。ELISA法检测TTR浓度。比较4组患者的年龄、孕次、产次、孕周、母血清TTR浓度等指标。结果:4组患者的年龄、孕次、产次、孕周等比较,差异无统计学意义(P0.05)。FGR组、s PE组及s PE+FGR组的母血TTR浓度较对照组明显降低,差异有统计学意义(P0.01)。s PE组血清中TTR含量低于FGR组,差异有统计学意义(P0.01)。结论:TTR在s PE、FGR和s PE+FGR孕妇血清中表达下调,有望成为s PE及FGR发生的生物标志物。s PE合并FGR可能由s PE本身的病理变化引起,s PE与FGR有着共同的病理基础。     

重度子痫前期并发胸腹腔积液15例临床分析

目的:探讨重度子痫前期并发胸腹腔积液的临床特点和救治方法.方法:回顾性分析我院2005年1月至2006年11月重度子痫前期并发胸腹腔积液患者15例的临床病例资料.结果:15例患者均有不同程度的高血压、低蛋白血症的表现,合并胸腔积液多表现为胸闷、呼吸困难和血氧饱和度下降;2例压迫症状严重的患者入院后及时剖宫产结束分娩,另13例经治疗后平均延长孕周4.5±1.5天;15例患者经治疗后,胸腹腔积液于术后5～12天内逐渐消失,术后12天左右出院.15例共分娩16例新生儿,死亡1例,其余近期预后好.结论:重度子痫前期并发胸腹腔积液患者病情极其严重,应及早发现并进行解痉、纠正低蛋白血症、降压和支持等综合治疗,适时终止妊娠是唯一有效控制病情的方法.     

子痫前期并发HELLP综合征及微血管病变的诊治

HELLP综合征主要病理生理表现为全身小动脉痉挛、微血管病变,一旦发生会危及母儿生命。加强围生期监护、解痉、糖皮质激素治疗和适时终止妊娠等尤为重要。     

早发型重度子痫前期的期待治疗

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.     

重度子(癎)前期并发腹水的临床特点和终止妊娠时机的探讨

目的 探讨重度子(癎)前期并发腹水的临床特点及终止妊娠时机. 方法 对179例重度子(癎)前期患者的临床资料进行回顾性分析,根据有无并发腹水分为腹水组(32例)和非腹水组(147例),分析两组孕妇一般情况、分娩方式、合并症/并发症(包括子(癎)、HELLP综合征、肝肾功能不全、心功能不全、低蛋白血症、胎盘早剥、产后出血、产褥感染).收集两组围产儿(腹水组38例,无腹水组157例)的临床资料,分别比较两组间和腹水组内胎龄＜32周,32周～,34周～,36周～组的小于胎龄儿(small for gestational age,SGA)的发生率和死亡率. 结果 (1)腹水组平均入院孕周和平均分娩孕周均早于无腹水组[入院:(32.5±2.1)周和(36.1±3.5)周,分娩:(34.1±2.3)周和(37.2±1.5)周,P均＜0.05).腹水组系统产前检查率低于无腹水组(25.0%和53.7%,P＜0.05).腹水组低蛋白血症(100.0%和47.0%)、肝肾功能不全(31.2%和8.2%)、HELLP综合征(9.4%和2.0%)、产后出血发生率(18.8%和2.0%)均高于无腹水组(P均＜0.05).(2)腹水组不同胎龄围产儿SGA发生率均高于同胎龄无腹水组,但仅胎龄＞36周组差异有统计学意义(7/9和30.2%,P＜0.05).腹水组胎龄＜32周和32周～围产儿死亡率高于无腹水组(＜32周:69.2%和19.2%,P＜0.05;32周～:2/7和0,P＜0.05).(3)腹水组内围产儿胎龄＜32周时围产儿死亡率较其他胎龄组高,胎龄＞36周围产儿SGA发生率最高(P＜0.05). 结论 重度子(癎)前期并发腹水发病早,并发症多,母婴预后不佳.腹水是重度子(癎)前期的一个危险信号,应该引起产科医生的高度重视.对于重度子(癎)前期并发腹水围产儿,32～36周可能为终止妊娠的良好时机.     

Expectant management in pregnant women with early and severe preeclampsia and concomitant risk factors

AimThe aim of this study was to demonstrate that women with severe early-onset preeclampsia and concomitant risk factors benefit from expectant management.MethodsThis retrospective study was conducted between January 2009 and December 2010. Stable women with severe preeclampsia between 23 + 6 and 33 + 6 weeks of gestation were admitted to the IOCU for conservative management. They were classified into two groups: those with concomitant risk factors, i.e. associated medical conditions, HELLP syndrome, severe oligohydramnios, fetal growth restriction and multiple pregnancies (group A) and those without (group B). P values lesser than 0.05 were considered statistically significant.ResultsNo significant differences were found in maternal and perinatal outcomes between groups. Neither were differences observed in pregnancy prolongation (mean: 8.42 days (SD ± 7.462) in group A and 10.5 days (SD ± 8.235) in group B (p = 0.391)). At the start of expectant management, 31.8% of fetuses had an abnormal middle cerebral artery Doppler; prior to delivery, this percentage was 77.4%.ConclusionPregnant women with severe early-onset preeclampsia and associated risk factors benefited from expectant management. During expectant management using a continuous magnesium sulfate regimen, the majority of fetuses showed cerebral vasodilatation. The exact clinical value of this finding should be clarified in further studies     

Comparisons of maternal and perinatal outcomes in Taiwanese women with complete and partial HELLP syndrome and women with severe pre-eclampsia without HELLP

AIM: To analyze the variations between maternal complications and perinatal outcome among women with complete hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome, partial HELLP syndrome, and women with severe pre-eclampsia and normal laboratory tests. We also examine the effect of corticosteroid therapy for treatment of HELLP. METHODS: In this retrospective study, six patients with complete HELLP syndrome and 46 with partial HELLP syndrome, were compared and contrasted with 212 patients with severe pre-eclampsia but without HELLP syndrome. RESULTS: In Protocol 1, multiple organ dysfunction syndrome (MODS) was the strongest morbidity factor associated with patients among complete HELLP, partial HELLP, and severe pre-eclampsia. After post-hoc analysis, disseminated intravascular coagulation (DIC) was the significant outcome variable between complete and partial HELLP. In Protocol 2, after adjustment, we found that MODS (adjusted OR, 15.2, 95% CI, 6.18-35.53; P < 0.001); Apgar score less than 5 at 1 minute (adjusted OR, 2.17, 95% CI, 0.94-5.01; P = 0.069) and DIC (adjusted OR, 9.51, 95% CI, 1.68-53.7, P = 0.011) remained significantly associated with HELLP syndrome. There was a favorable outcome found in the complete HELLP group. Neither the dexamethasone group nor the aggressive therapy group could benefit from the treatment protocol. CONCLUSION: The different categories of HELLP syndrome, the protocol 1 and protocol 2 have been noted as differential effects on pregnancy outcome. MODS and DIC would be two significant outcome variables and corticosteroid therapy may not benefit HELLP patients.     

Retinal detachment in association with pre-eclampsia, eclampsia, and HELLP syndrome

Objective

To review case reports of retinal detachment in women with pre-eclampsia/eclampsia.

Methods

Medline was searched for case reports of retinal detachment associated with pre-eclampsia/eclampsia. Articles written in English, Spanish, or Portuguese and published between 1990 and 2010 were reviewed.

Results

A total of 28 cases of retinal detachment were identified; 15 were associated with severe pre-eclampsia (3 of these probably had hemolysis, elevated liver enzymes, and low platelets [HELLP] syndrome), 9 with HELLP syndrome, 2 with eclampsia, and 2 with both HELLP syndrome and eclampsia. The majority (60%) of women were nulliparous, 4 had abruptio placentae, and cesarean delivery was performed in 76%. Retinal detachment was bilateral in 89% and associated with delivery of the fetus in 96%; 69% were diagnosed postpartum. Within 2-12 weeks postpartum, all patients had complete recovery of vision with clinical management.

Conclusion

Retinal detachment in pre-eclampsia/eclampsia might be associated with HELLP syndrome, indicating that microangiophatic hemolysis might have a role in the pathophysiology of retinal detachment. Its occurrence might not be correlated with the severity of pre-eclampsia because pre-eclampsia is a constellation of signs and symptoms (persistent vasospasms with hemolysis and hypoalbuminemia) rather than simply being hypertension.     

早发型重度子痫前期患者分娩孕周对母儿结局的影响

目的 分析早发型重度子痫前期患者分娩孕周对母儿结局的影响,探讨终止妊娠的适宜时机.方法 回顾性分析于1999年7月1日至2009年6月30日的10年间在北京大学第一医院住院治疗并分娩的、终止妊娠孕周＞28周的单胎妊娠早发型重度子痫前期(发病孕周＜34周)患者221例的临床资料,按终止妊娠孕周分为3组,Ⅰ组为孕28～31周+6分娩,81例,Ⅱ组为孕32～33周+6分娩,78例,Ⅲ组为孕≥34周分娩,62例;比较3组患者的临床特点及母儿结局.结果 (1)围产儿结局:221例围产儿中共有13例失访,Ⅰ组9例,Ⅱ组3例,Ⅲ组1例.新生儿呼吸窘迫综合征(RDS)发生率Ⅰ组为26%(19/72),Ⅱ组为7%(5/75),Ⅲ组为10%(6/61),Ⅰ组明显高于其他两组,差异有统计学意义(P＜0.05);围产儿死亡率Ⅰ组为43%(31/72),Ⅱ组为28%(21/75),Ⅲ组为3%(2/61),Ⅰ组明显高于其他两组,差异也有统计学意义(P＜0.05);3组孕产妇并发症发生情况比较,差异均无统计学意义(P＞0.05).(2)围产儿死亡原因:因社会因素(家属放弃治疗)导致的围产儿死亡,Ⅰ组为26%(8/31),Ⅱ组为67%(14/21),Ⅲ组为1/2,3组分别比较,差异均有统计学意义(P＜0.05).结论 早发型重度子痫前期孕妇孕32周后分娩,早产儿RDS发病率明显下降,孕34周后分娩,围产儿死亡率明显下降.尽量减少社会因素的影响,有可能进一步提高早发型重度子痫前期围产儿的存活率.     

Expectant management of severe preeclampsia with severe fetal growth restriction in the second trimester

ObjectiveWe investigated whether women with severe fetal growth restriction (FGR <5th percentile) associated with severe preeclampsia (PE) occurring in the second trimester are candidates for expectant management.Study designThis is a retrospective study involving 33 women who developed severe PE or superimposed PE in the second trimester and were expectantly managed at a tertiary center. They were divided into groups with and without severe FGR on admission (severe FGR (+) group: 17 women; severe FGR (−) group: 16 women) for comparison of the duration of pregnancy prolongation, major maternal complications, and perinatal outcomes. The data are presented as medians (range) or frequencies (percentage).ResultsThe duration of pregnancy prolongation was 10 days in both groups. Major maternal complications occurred in 5 of 17 women (29.4%) in the severe FGR (+) and 5 of 16 (31.3%) in the severe FGR (−) group, showing very similar incidence rates in the 2 groups. The perinatal survival rates were favorable at 82.4% (14/17) in the severe FGR (+) and 100% (16/16) in the severe FGR (−) group.ConclusionRegarding expectant management of severe preeclampsia occurring in the second trimester, there was no difference in the duration of pregnancy prolongation between the groups with and without severe FGR on admission. Because favorable perinatal outcomes can be expected without compromising maternal safety by prolonging pregnancy as expectant management for severe FGR, it was suggested that women with severe FGR are suitable candidates for expectant management.