早发型重度子痫前期妊娠结局探讨

目的:探讨早发型重度子痫前期的母儿结局，为临床处理提供参考。方法:回顾性分析重度子痫前期病例107例，按发病孕周分成早发型重度子痫前期（≤33+6周）（A组）35例和晚发型重度子痫前期（≥34周）（B组）72例，观察2组一般情况、孕产妇的并发症及分娩方式和围生儿结局。结果:A组孕妇有子痫前期病史、合并甲状腺疾病及糖异常发生率均明显高于B组（P<0.01）；A组孕产妇肾功能异常45.7%和肝功能异常42.9%，均明显高于B组的9.7%和5.6%（P<0.01）。B组HELLP综合征、子痫、胎盘早剥、心力衰竭和贫血发生率差异均无统计学意义（P>0.05）；B组围生儿胎儿生长受限发生率及围生儿死亡率均低于A组（P<0.01和P<0.05）。结论:早发型重度子痫前期有较高的母婴并发症发生率，在终止妊娠前可有短期的期待治疗；给予积极的治疗可明显改善母儿的结局,但在期待治疗过程中,应严密监护母婴情况,适时终止妊娠。

Pregnancy outcome of the early-onset severe preeclampsia

Objective:To explore the maternal and neonatal outcomes in the early-onset severe preeclampsia for providing the reference in clinic. Methods:The clinical data of 107 patients with severe preeclampsia were retrospectively analyzed,and the patients were divided into the early-onset severe preeclampsia ( 35 cases, group A with pregnancy ≤33 +6 weeks,) and late-onset severe preeclampsia( 72 cases, group B with pregnancy ≥34 weeks ) according to the onset gestational week. The general condition, complication,delivery mode and perineonate outcome were observed in two groups. Results:The incidence rates of preeclampsia, preeclampsia complicated with thyroid disease or abnormal glucose metabolism in group A were significantly higher than those in group B(P<0. 01). The incidence rates of abnormal renal function and liver function in group A(45. 7% and 42. 9%) were obviously higher than those in group B(9. 7% and 5. 6%),respectively(P <0. 01). There were not statistical difference in the incidence rates of HELLP syndrome,eclampsia,abruptio placentae,cardiac failure and anemia in group B(P>0. 05). The incidence rates of fetal growth restriction and mortality of perineonates in group B were less than that in group A(P<0. 01 and P<0. 05). Conclusions:There is high frequency of maternal and neonatal complications in patients with the early-onset severe preeclampsia, and the short-term expectant treatment can be implemented before the termination of pregnancy. The active treatment can significantly improve the maternal and neonatal outcomes,but the maternal and neonatal condition should be closely monitored,and the pregnancy should be timely terminated during the expectant treatment.