早发型与晚发型重度子痫前期特点及终止妊娠时机选择

目的:探讨早发型与晚发型重度子痫前期特点及终止妊娠时机选择。方法:对重度子痫前期孕妇47例以孕34周为界分为早发型重度子痫前期组17例和晚发型重度子痫前期组30例的临床资料及围产结局进行综合分析。结果:两组的年龄、≥35岁比例、孕产次、血压、高血压病史差异无统计学意义(P均>0.05),两组24 h尿蛋白定量、肌酐差异有统计学意义(P<0.01),而PT、APTT、血小板、ALT、AST、尿酸差异无统计学意义(P均>0.05)。两组在分娩前治疗时间、分娩孕周、胎盘早剥、腹水差异有统计学意义(P<0.05),在分娩方式、羊水过少、合并ICP、合并GDM的发生率差异无统计学意义(P均>0.05)。两组在新生儿出生体重、低体重儿比例、新生儿放弃抢救、新生儿窒息、死胎、死产差异有统计学意义(P<0.05)。结论:早发型重度子痫前期起病急、病情重、并发症多、母儿预后差,而晚发型相对较温和。对于孕周较小的早发型重度子痫前期,严密监护下延长孕周降低围产儿不良并发症及死亡率,再适时终止妊娠以最大限度降低母儿并发症的发生。

Characteristics of early-onset and late-onset severe preeclampsia and the choice of opportunity of pregnancy termination

Objective:To explore the characteristics of early-onset and late-onset severe preeclampsia and the choice of opportunity of pregnancy termination.Methods:Forty-seven pregnant women with severe preeclampsia were divided into early-onset severe preeclampsia group(17 cases) and late-onset severe preeclampsia group(30 cases) with 34 gestational weeks as boundary,then the clinical data and perinatal outcomes in the two groups were analyzed comprehensively.Results:There was no statistically significant difference in age,the proportion of cases≥ 35 years,the times of pregnancy and delivery,blood pressure,and medical history of hypertension between the two groups(P>0.05).There was statistically significant difference in 24-hour urine protein and creatinine between the two groups(P<0.01),but there was no statistically significant difference in PT,APTT,platelet,ALT,AST,and uric acid between the two groups(P>0.05).There was statistically significant difference in curative time before delivery,gestational weeks at delivery,the incidences of placental abruption and ascites between the two groups(P<0.05),there was no statistically significant difference in the incidences of delivery modes,oligohydramnion,combing with ICP,and combing with GDM between the two groups(P>0.05).There was statistically significant difference in neonatal birth weight,the proportion of low birth weight infants,giving up rescue,neonatal asphyxia,and stillbirth between the two groups(P<0.05).Conclusion:The onset of early-onset severe preeclampsia is rapid,the illness is severe,the complications are various,and maternal and fetal prognosis are poor,while late-onset severe preeclampsia is moderate.For the patients with early-onset severe preeclampsia and less gestational weeks,prolonging gestational weeks under close monitoring can reduce the complications and mortality of perinatal infants,terminating pregnancy appropriately can reduce the occurrence of maternal and fetal complications to the greatest extent.