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.

Effects of gestational age on perinatal outcomes in patients complicated with early onset severe preeclampsia

Objective To analysis the relationship between gestational age and perinatal outcomes in patients complicated with early onset severe preeclampsia.Methods Retrospective study was conducted on clinical documents of 221 patients with early onset severe preeclampsia( ＜ 34 weeks) who delivered after 28 gestational weeks in Peking University First Hospital from July 1999 to June 2009.Patients were divided into three groups based on gestational weeks at delivery: group Ⅰ (n = 81 ) delivered at 28 -31 weeks+6,group Ⅱ (n = 78) at 32 -33 weeks+6 and group Ⅲ (n = 62) after 34 weeks.The clinical characteristics and perinatal outcomes were compared among those three groups.Results ( 1 ) Outcome of neonates:Among 221 neonates, 13 neonates lost follow-up, including 9 in group Ⅰ , 3 in group Ⅱ, 1 in group Ⅲ.The incidence of neonatal respiratory distress syndrome ( RDS ) of 26% ( 19/72 ) in group Ⅰ were significantly higher than 7% (5/75) in group Ⅱ and 10% (6/61) in group Ⅲ (P ＜ 0.05 ).The neonatal mortality rate of (43% ,31/72) in group Ⅰ were significantly higher than 3% (2/61) in group Ⅲ and 28%(21/75) in group Ⅱ (P ＜0.05 ).The incidence of maternal complications showed no statistical difference among three groups.(2) Neonatal death analysis: all neonatal death were due to parents' give up, including 26%(8/31) in group Ⅰ, 67% (14/21)in group Ⅱ and 1/2 in group Ⅲ, which reached statistical difference(P＜0.05).Conclusions The incidence of neonatal RDS in mother with early onset severe preeclampsia was decreased if delivered after 32 weeks, and the perinatal mortality was remarkably decreased if delivered after 34 weeks.Therefore, the perinatal survival rate in women with early onset severe preeclampsia can be improved by minimizing the impact of social factors.