摘要
目的探讨子痫前期(PE)患者的妊娠结局。方法回顾性分析2013年1月1日-2019年4月30日在陆军军医大学大坪医院分娩的孕产妇26 206例,诊断按第8、9版妇产科教材,剔除糖尿病合并妊娠62例、甲状腺功能减退合并妊娠445例、羊水过多180例、巨大儿(≥4 kg)1592例、慢性高血压合并PE 89例、多胎妊娠629例,剩余共23 209例。将最后诊断为PE的532例孕产妇作为观察组,其中轻度PE组134例,重度PE组398例,其余22 677例作为对照组。分别比较3组孕产妇年龄、孕周、产次、分娩方式、妊娠并发症及新生儿情况,并详细分析各组间甲状腺功能。结果轻度PE组高龄孕产妇所占比例为29.2%,重度PE组为20.6%,均明显高于对照组(12.4%,P<0.05)。轻度PE组早产率、剖宫产率(分别为19.7%、55.0%)及重度PE组早产率、剖宫产率(分别为70.1%、94.2%)均明显高于对照组(分别为10.0%,48.2%,P<0.05);轻度PE组妊娠期甲状腺功能减退发病率、妊娠肝内胆汁淤积症(ICP)发病率、小于孕龄儿的发生率(分别为26.9%、10.5%、7.5%)及重度PE组妊娠期甲状腺功能减退发病率、ICP发病率、小于孕龄儿的发生率(分别为23.9%、9.3%、22.1%)均明显高于对照组(分别为17.5%、3.5%、2.9%,P<0.05);重度PE组胎盘早剥发生率、死胎的发生率(分别为3.8%、7.3%)均明显高于对照组(分别为0.6%、0.7%,P<0.05);轻度PE组妊娠糖尿病(GDM)发病率(41.8%)明显高于对照组(30.0%,P<0.05);重度PE组脐带绕颈发生率(17.6%)明显低于对照组(25.1%,P<0.05)。结论 PE患者的并发症及治疗性早产率均增高,妊娠期甲状腺功能减退为其潜在的危险因素,需要加强临床监管及防控。
Objective To investigate the pregnancy outcome of patients with preeclampsia(PE). Methods The data of 26 206 pregnant and lying-in women were retrospective analyzed who gave birth in Daping Hospital of the Army Medical University from Jan. 1, 2013 to Apr. 30, 2019, diagnosed with the 8 th and 9 th version of gynecology and obstetrics textbook. Excluding 62 cases of diabetes combined pregnancy, 445 cases of hypothyroidism combined pregnancy, 180 cases of polyhydramnios, 1592 cases of macrosomia(≥4 kg), 89 cases of chronic hypertension with PE, and 629 cases of multifetation. The remaining 23 209 cases, according to the final diagnosis, were divided into PE group(532 cases) which was divided again into mild-PE group(134 cases) and severe-PE groups(398 cases), and the 22 677 remainders acted as the control group. The age, gestational weeks, number of births, mode of delivery, pregnancy complications and neonatal status in the three groups were compared, and the thyroid function among the groups was analyzed in detail. Results The proportion of elderly parturients was higher in both mild-PE group(29.2%) and severe-PE groups(20.6%) than that in control group(12.4%). The rates of premature delivery and cesarean section were higher in both mild-PE group(19.7% and 55.0%) and severe-PE groups(70.1% and 94.2%) than those in control group(10.0% and 48.2%). The incidences of hypothyroidism during pregnancy, intrahepatic cholestasis of pregnancy(ICP) and infants younger than gestational age were higher in both mild-PE group(26.9%, 10.5% and 7.5%) and severe-PE groups(23.9%, 9.3% and 22.1%) than those in control group(17.5%, 3.5% and 2.9%);The incidences of placental abruption and stillborn foetus were obviouslyhigher in severe-PE group(3.8% and 7.3%) than those in control group(0.6% and 0.7%). The incidence of gestational diabetes was significantly higher in mild-PE group(41.8%) than that in control group(30.0%), and of umbilical cord around neck was significantly lower in severe-PE group(17.6%) than that in control group(25.1%). Conclusions The incidences of complications and therapeutic premature delivery in PE patients is increased. Hypothyroidism during pregnancy is a potential risk factor and should be strenuously supervised.
作者
朱大伟
刘阳
黄洁
郑秀惠
韩健
郭建新
李力
ZHU Da-wei;LIU Yang;HUANG Jie;ZHENG Xiu-hui;HAN Jian;GUO Jian-xin;LI Li(Department of Obstetrics and Gynecology,Daping Hospital,Army Medical University,Chongqing 400042,China;Department of Information,Daping Hospital,Army Medical University,Chongqing 400042,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2019年第11期931-935,共5页
Medical Journal of Chinese People's Liberation Army
基金
国家自然科学基金(31470886)~~
关键词
孕产妇
子痫前期
妊娠结局
甲状腺功能
maternal
preeclampsia
pregnancy outcome
thyroid function
