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目的探讨期待治疗对不同孕周早发型重度子痫前期母儿结局的影响。方法选择2000年3月至2008年3月收治的早发型重度子痫前期患者74例行期待治疗,胎儿及其新生儿80例。根据发病孕周不同分为3组:A组15例(孕周<28周),双胎1例;B组28例(28周≤孕周<32周),双胎2例;C组31例(32周≤孕周<34周),双胎3例。比较各组期待治疗孕产妇及围产儿并发症的发生情况。结果(1)孕妇并发症发生率:A组46.7%,B组42.9%,C组32.3%,3组间比较差异无统计学意义(P>0.05)。(2)胎儿窘迫、胎死宫内、新生儿窒息及新生儿死亡的发生率随孕周增长而下降,差异有统计学意义(P均<0.05)。(3)B组期待治疗时间(16.5±9.4)d显著长于A组(9.8±4.7)d和C组(10.1±8.2)d(P<0.05)。终止妊娠孕周A组(28.9±2.6)周,B组(32.8±2.3)周,C组(34.2±1.2)周,3组间比较差异有统计学意义(P<0.05)。剖宫产率比较,A组93.3%,B组96.4%,C组93.5%,3组间比较差异无统计学意义(P>0.05)。结论早发型重度子痫前期严重影响母婴预后,适当期限的期待治疗可以改善母婴结局,剖宫产仍是终止重度子痫前期的主要方法。
Objective To investigate the effect of expectant treatment on maternal and infant outcomes of early-onset severe preeclampsia in different gestation weeks. Methods 74 patients with early-onset severe preeclampsia who were treated from March 2000 to March 2008 were enrolled in this study. The fetuses and their newborns were treated with 80 cases. According to the different gestational age, they were divided into 3 groups: 15 cases in group A (gestational age <28 weeks) and 1 case in twins; 28 cases in group B (28 weeks ≤ gestational weeks <32 weeks), twins in 2 cases; Cases (32 weeks ≤ gestational weeks <34 weeks), twins in 3 cases. The incidence of complications of expectant mothers and perinatals in each group was compared. Results (1) The incidence of complications in pregnant women was 46.7% in group A, 42.9% in group B and 32.3% in group C, with no significant difference between the three groups (P> 0.05). (2) The incidence of fetal distress, intrauterine fetal death, neonatal asphyxia and neonatal death decreased with gestational age increasing, the difference was statistically significant (all P <0.05). (3) The expected duration of treatment in group B (16.5 ± 9.4) d was significantly longer than that in group A (9.8 ± 4.7) d and group C (10.1 ± 8.2) d (P <0.05). The gestational age at the end of gestational week in group A (28.9 ± 2.6) weeks, group B (32.8 ± 2.3) weeks, group C (34.2 ± 1.2) weeks, the difference between the three groups was statistically significant (P <0.05). The cesarean section rate was 93.3% in group A, 96.4% in group B and 93.5% in group C, with no significant difference between the three groups (P> 0.05). Conclusion Early preeclampsia with severe preeclampsia has a serious impact on prognosis of maternal and infant. Expectant treatment with appropriate duration can improve maternal and infant outcomes. Cesarean section is still the main method to terminate severe preeclampsia.