妊娠合并肾脏疾病28例的产科处理

目的探讨妊娠合并肾脏疾病的产科处理。方法对妊娠合并肾脏疾病28例病例的产科处理做回顾性分析。结果28例妊娠合并肾脏疾病中合并肾炎的发病率最高(20/28),妊娠并发症中妊娠期高血压疾病发生率最高(10/28)。24例肾功能代偿期孕妇均定期接受产科检查,除1例孕13周时行人工流产术外,其余23例均足月正常分娩,母儿预后良好;3例合并妊娠期高血压疾病子痫前期(重度)、肾功能不全(氮质血症期),除1例早产外,另2例剖宫产终止妊娠,母儿预后良好;另有1例孕期未进行产前检查,孕24周合并妊娠期高血压疾病子痫前期(重度),胎儿宫内发育迟缓,肾功能不全(尿毒症期),以剖宫产终止妊娠,胎儿死亡。结论妊娠结局与妊娠合并肾脏疾病中肾功能的分期和有无妊娠并发症密切相关;孕期检查和适时、适当的产科处理对于围生儿、孕妇的预后至关重要。

Obstetrics Treatment of 28 Cases of Pregnancy with Kidney Disease

Objective:To study the obstetrics treatment of pregnancy with kidney disease.Methods:The clinical data of 28 cases of pregnancies with kidney disease enrolled in our hospital in the last 14 years were analyzed retrospectively.Results:Among the 28 cases of renal diseases,nephrites had the highest incidence (20/28),and hypertension is the most common disease complicated with pregnancy.24 cases whose renal function were in compensation period had regular antenatal examination,and normal pregnant outcome,except 1 case received D&C because of hydropigenous nephritis.Tow in three cases with PIH and renal inadequacy (azotemia period) had Cesarean section at 37,35 weeks' gestation respectively,with normal outcome for the mothers and the infants,the other one had premature rupture of membranes at 32 weeks' gestation.One case with renal function in uremia period had no prenatal examination,and terminated pregnancy at 24 weeks' gestation through Cesarean section.The newborn died and the mother received dialysis.Conclusions:The outcome of pregnancy is highly correlated with the stage of renal function and the occurrence of complications with pregnancy.Regular prenatal examinations,proper medical intervention at appropriate time are crucial to the outcome of the mothers and infants.