正常高值血压孕产妇凝血指标与妊娠结局的临床分析

目的:探讨正常高值血压孕产妇的凝血指标与妊娠结局。方法:回顾性分析2015～2017年在本院产检并分娩的1 500例孕妇的临床资料,其中正常高值血压组、正常血压组、妊娠期高血压疾病(HDP)组各500例,将一般资料、孕晚期血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(FIB)与妊娠结局进行分析。结果:正常高值血压组孕产妇孕次、产次、孕前体质指数(BMI)、孕期增重(GWG)以及孕晚期PT、FIB、剖宫产率,与正常血压组孕产妇差异有统计学意义(P0.05)。正常高值血压组孕产妇孕前BMI,孕晚期PLT、MPV、PDW、PT、APTT,胎盘早剥、产后出血、剖宫产率、早产、羊水过少、小于孕龄儿及胎儿窘迫,与HDP组孕产妇差异有统计学意义(P0.05)。结论:正常高值血压孕产妇部分凝血指标发生变化,除剖宫产率升高外,不良妊娠结局并未显著增加,临床一般无需特别纳入妊娠期高血压疾病管理。

Clinical study on coagulation parameters and gestational outcomes of pregnant women with high normal blood pressure

Objective: To investigate the coagulation parameters and pregnancy outcomes of pregnant women with high normal blood pressure. Methods: The clinical data of 1500 pregnant women who were antenatalcared and delivered in our hospital from 2015 to 2017 were retrospectively analyzed. All of the women were divided into three groups with 500 women in each group:high normal blood pressure group, normal blood pressure group, and hypertensive disorders of pregnancy (HDP) group. The general clinical data, platelet count (PLT), mean platelet volume (MPV), platelet distributing width (PDW), thrombin time (TT), prothrombin time (PT), activated partial thromboptastin time (APTT), and fibrinogen (FIB) in third trimester, and pregnancy outcome were analyzed. Results: There were significant differences between the high normal blood pressure group and the normal blood pressure group in gravidity, parity, birth order, pre-pregnancy body mass index (BMI), gestational weight gain (GWG), PT, FIB in third trimester and cesarean section rate (P<0.05). There were significant differences between the high normal blood pressure group and the HDP group in pre-pregnancy BMI, PLT, MPV, PDW, PT, APTT in third trimester, placental abruption, postpartum hemorrhage, cesarean section rate, preterm birth, oligohydramnios, small for gestation age, and fetal distress (P<0.05). Conclusions: Some coagulation indexes of pregnant women with high normal blood pressure have changed, except for the increase of cesarean section rate, adverse pregnancy outcomes have not significantly increased, and generally high normal blood pressure pregnant women need not be included in the management of hypertensive disorders of pregnancy.