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目的探讨早产合并早发型与晚发型严重子痫前期妊娠结局。方法选取2004年11月至2012年1月于遵义医学院第五附属(珠海)医院及广州医科大学附属第三医院重症孕产妇救治中心收治的单胎早产合并严重子痫前期的198例患者的临床资料进行回顾性分析,以孕34周为界,将早发型严重子痫前期患者作为观察组(n=121),晚发型严重子痫前期患者作为对照组(n=77),比较两组患者的临床特点及妊娠结局。结果观察组未定期产检率及疤痕子宫发生率明显高于对照组(62.0%vs 42.9%,20.7%vs 1.3%,P<0.05);观察组和对照组母亲合并症/并发症总的发生率分别为65.3%和50.6%,比较差异有统计学意义(P<0.05);其中,观察组心功能不全发生率较对照组显著升高(18.2%vs 7.8%,P<0.05);以胎盘早剥为最常见并发症(15.7%vs 14.3%,P>0.05)。两组围产儿并发症总的发生率分别为80.2%和63.6%(P<0.05),观察组胎儿窘迫及新生儿重度窒息发生率明显高于对照组,差异均有统计学意义(P<0.05)。两组其他方面比较差异无统计学意义(P>0.05)。结论早产合并早发型与晚发型严重子痫前期相比,早发型孕妇病情重、并发症多,围产儿预后不佳。建议加强孕期保健、定期产检的宣教工作,并应根据母胎情况,适时终止妊娠。
Objective To investigate the outcomes of preterm labor with early-onset and late-onset severe preeclampsia. Methods A total of 198 patients with singleton preterm birth and severe preeclampsia who were admitted to the Fifth Affiliated Hospital of Zunyi Medical College (Zhuhai) Hospital and the Third Affiliated Hospital of Guangzhou Medical University from November 2004 to January 2012 were enrolled in this study. The clinical data were retrospectively analyzed. The patients with early-onset severe preeclampsia were selected as observation group (n = 121) and late-onset severe preeclampsia patients as control group (n = 77) The patient’s clinical characteristics and pregnancy outcome. Results The rate of unscheduled births and the incidence of uterine scar in the observation group was significantly higher than that in the control group (62.0% vs 42.9%, 20.7% vs 1.3%, P <0.05). The overall incidence of maternal complications / complications in the observation and control groups (P <0.05). The incidence of cardiac dysfunction in the observation group was significantly higher than that in the control group (18.2% vs 7.8%, P <0.05) Peeling was the most common complication (15.7% vs 14.3%, P> 0.05). The overall incidence of perinatal complications in the two groups were 80.2% and 63.6%, respectively (P <0.05). The incidences of fetal distress and neonatal severe asphyxia in the observation group were significantly higher than those in the control group (P <0.05) ). The other two groups showed no significant difference (P> 0.05). Conclusions Compared with late-onset severe preeclampsia, premature pregnant women with early-onset and early-onset premature pregnancies have severe illness, many complications and poor prognosis. Propose to strengthen the pregnancy health care, regular inspection of the missionary work, and should be based on the mother’s fetus, timely termination of pregnancy.