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目的探讨124例晚发型子痫前期胎盘的临床病理特点及预后。方法参照子痫前期诊断标准进行分类,124例晚发型子痫前期病例分为轻度组(83例)和重度组(41例),对2组患者的一般临床资料、胎盘组织病理特点及围产结局进行分析、比较。结果两组病例中胎盘主要的镜下改变包括蜕膜血管病变、梗死、胎盘早剥和绒毛发育不良,其中胎盘绒毛发育不良的发生率最高,其次是胎盘梗死。轻度组中轻度蜕膜血管病的发病率为21.7%(18/83)、重度组中的发病率为56.1%(23/41),两组间比较有显著差异(P<0.01)。轻度组中胎盘绒毛发育不良的发病率为40.9%(34/83),重度组为70.7%(29/41),两组间差异显著(P<0.05)。轻度组中胎儿宫内生长受限的发生率为21.7%(18/83),重度组为41.5%(17/41),两组间差异显著(P<0.05)。轻度组中胎儿存活率为98.8%(82/83),重度组为92.7%(38/41),两组间无明显差异(P>0.05)。另外重度蜕膜血管病、胎盘梗死、脐带异常及合并糖尿病方面两组比较无明显差异。结论晚发型重度子痫前期组的胎儿宫内生长受限的发生率高于轻度组。两组间胎儿存活率无明显差异,子痫前期预后不良。晚发型重度子痫前期的部分围生结局差于轻度组。
Objective To investigate the clinicopathological features and prognosis of 124 patients with late-onset preeclampsia placenta. Methods According to the diagnostic criteria of preeclampsia, 124 cases of late-onset preeclampsia were divided into mild group (83 cases) and severe group (41 cases). The clinical data, histopathological characteristics of placenta, Produce the outcome analysis, comparison. Results The main microscopic changes of the placenta in both groups included decidual vascular disease, infarction, placental abruption and villous dysplasia, with the highest incidence of placental villous hypoplasia, followed by placental infarction. The incidence of mild decidual vascular disease was 21.7% (18/83) in mild group and 56.1% (23/41) in severe group, with significant difference between the two groups (P <0.01). The prevalence of placental dysplasia was 40.9% (34/83) in mild group and 70.7% (29/41) in severe group, with significant difference between the two groups (P <0.05). The incidence of intrauterine growth restriction was 21.7% (18/83) in mild group and 41.5% (17/41) in severe group, with significant difference between the two groups (P <0.05). Fetal survival rate in mild group was 98.8% (82/83), severe group was 92.7% (38/41), no significant difference between the two groups (P> 0.05). In addition to severe decidual vascular disease, placental infarction, umbilical cord abnormalities and diabetes were no significant differences between the two groups. Conclusion The incidence of intrauterine growth restriction in late-onset severe preeclampsia group is higher than that in mild group. Fetal survival between the two groups no significant difference, poor prognosis of preeclampsia. Partial perinatal outcome of late-onset severe preeclampsia was worse than mild.