431例重度子痫前期的诊治与母儿妊娠结局分析

目的探讨重度子痫前期母婴预后的影响因素。方法对上海交通大学附属市六医院妇产科2005年1月-2010年12月收治的431例重度子痫前期患者的诊治过程进行回顾性分析并进行6月-5年产后随访。根据其发病孕周不同分两组,A组为早发型子痫前期:20周≤发病孕周<34周,B组为重度子痫前期(发病孕周≥34周),分析重度子痫前期的发病、诊治现状及母婴结局。结果重度子痫前期发病率2.27%,A组发病率(2.49%)高于B组(1.51%),P<0.05;重度子痫前期正规产检比率29.7%,A组正规产检率(24.35%)明显低于B组(41.32%),P<0.05;重度子痫前期产后随访率26.3%;重度子痫前期高中以上文化比率25.25%,A组(24.01%)明显低于B组(34.13%),P<0.05;重度子痫前期孕妇严重并发症发病率为48.72%,A组发生率(67.8%)明显高于B组(18.34%),P<0.05;两组有产检母婴并发症发生率低于无产检病人,(A组62.7%VS 69.26%,P>0.05,B组0 VS 31.63%),P<0.05;孕产妇死亡2例,均为早发型无产检患者;重度子痫前期围产儿死亡率20.65%,A组围产儿死亡率32.85%明显高于B组(1.8%),P<0.05;重度子痫前期产后远期并发症(包括持续高血压、尿蛋白、眼底病变、子痫前期再发)发生率14.15%,A组发生率(20.08%)明显高于B组(4.79%),P<0.05。结论无正规产检及系统治疗的重度子痫前期尤其早发型严重影响母婴预后,定期产检、及时诊治有助于改善母儿结局。

The perinatal examination and outcomes of 431 pregnancies complicated by severe preeclampsia

Objective： To evaluate the risk factors associated with of pregnancies complicated by severe preeclampsia Methods： a retrospective study with 431 pregnancies complicated by severe preeclampsia,assessed at Department of Obstetrics and Gynecology,Shanghai Jiaotong University No.6 People′s Hospital between January 2005 and December 2010.The diagnosis and disease severity were based on the values of blood pressure,proteinuria,and clinical and laboratory findings.The pregnant′s age,regular antennatal examination,culture degree,parity,blood pressure,urine protein semiquantitative values,umbilicus artery dopplervelocimetry,birth conditions,perinatal maternal and fetal complications,long-time maternal and fetal complications between 6 month and 5 years after post partum were compared between patients with early onset and late onset severe disease.The disease was considered to be of early onset when diagnosed at less than 34 weeks of gestational age.Results： The incidence rate of severe preeclampsia was 2.27%.The incidence rate of ES-PE was higher（2.49%）then that of LS-PE（1.51%）,P〈0.05;The culture degree of and the rate of regular antennatal examination were lower in ES-PE（24.01%）as compared to LS-PE（34.13%）,P〈0.05;The incidence rate of perinatal and long-time maternal and fetal morbidity were higher in ES-PE as compared to LS-PE,P〈0.05（67.8% versus18.34%,20.08% versus 4.79%）;The incidence rate of perinatal maternal and fetal morbidity were higher in ES-PE with no antennatal examination as compared to LS-PE with regular antennatal examination（group A 62.7% versus 69.26% P〈0.05,group B 0 versus 31.63%,P〈0.05）;The incidence rate of perinatal maternal and fetal mortality were higher in ES-PE as compared to LS-PE,P〈0.05.Conclusion： Early onset severe preeclampsia with unregular antennatal examination and treatment attending to has poor pregnancy outcome.Regular antennatal examination and treatment could be more important four improving pregnancy outcome in development country.