早发型子痫前期期待治疗的可行性及效果
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摘要
目的
探讨早发型子痫前期期待治疗的可行性以及效果。
方法
对1999年1月至2004年12月5年中115例早发型子痫前期病例进行研究,所有病例均满足孕34周前入院并能在本院住院直至分娩,入院前或入院时已确诊为子痫前期,且无妊娠合并慢性高血压、慢性肾炎、肾病综合征等条件。以延长8天为标准分为A组(延长小于8天)和B组(延长8天及以上),有67例归入A组(双胎8例,胎儿数75例),48例归入B组(双胎10例,三胎1例,胎儿数60例)。观察孕妇并发症及围产儿预后。
结果
1.2组孕妇产次、胎数、入院孕周、舒张压血压最高值、24小时尿蛋白定
ObjectiveTo explore the feasibility and efficacy of expectant management in early onset preeclampsia.Method115 cases of early onset preeclampsia in 5 years (between January 1999 to December 2004) were studied. All the cases were admitted before 34 gestational age and diagnosed as preeclampsia before or at that time. There is no chronic hypertension, chronic nephritis or nephrotic syndrome before pregnancy. Two groups were classified by prolonging 8 days as Group A (less than 8 days, sixty-seven cases including eight twins, and seventy-five fetus) and Group B (8 or more days, forty-eight cases including ten twins and one triplets, and sixty fetus). Maternal complications and perinatal prognosis were observed.Results1. There is no significant difference in parity, numbers of fetus, gestational age of admission, the highest level of diastolic pressure and the ratio of urine protein in twenty-four hours between the two groups (P>0.05). But maternal age and the
highest level of systolic pressure were statistically different(P=0.004,0.005).2. There is no significant difference in the using of magnesium sulfate, decompression drugs and nutrition supporting (P>0.05). But the days of magnesium sulfate using and the using of dexasone were statistically different (P<0.001).3. The mean days of prolongation were 8.2 days in all the cases, 3.4 days in Group A, 14.8 days in Group B, with significant difference between them (P<0.001).4. There were no significant difference between maternal major complications including hypoproteinemia, hepatic dysfunction, renal dysfunction, anemia, thrombocytopenia, placental abruption, HELLP syndrome and eclampsia(P>0.05).5. There gestational age of delivery (31.8VS 33.2, P<0.001) and birth weight (1583.4VS 1811.2 g, P=0.028) were significantly different.6. Perinatal death was nineteen (14.1%) including fourteen fetal death (thirteen in group A and one in group B with significantly different, P=0.003) and five neonate death (one of twins and two single fetal in group A;one twins in group B without significant difference, P=0.839).7. There was no significant difference in perinatal complications such as premature labor, neonatal asphyxia, neonatal respiratory distress syndrome, fetal growth restriction, transient tachypnea, hyperbilinibinemia, neonatal malformation between the two groups (P>0.05).Conclusions1. Expectant management is feasible and effective in early onset preeclampsia. hi the balance of maternal-fetal condition, expectant management can prolong gestation age and get better prenatal prognosis.2. It is the critical time that the first twenty-four hours after admission. Dexasone
could be used to prompt the maturity of fetal lung in this period and decision could be made to continue expectant management or terminate immediately according to the situation.3. It is of vital importance to monitor maternal and fetal situation intimately in the course of expectant management, which could make accurate judgment in time and deal with any omen properly to avoid serious maternal complications and fetal death.4.Early onset preeclampsia should be deal with in tristeranty hospital. Sufficient neonatal intensive care unit appliance and serve would show positive effect in reducing neonatal complications.
探讨早发型子痫前期期待治疗的可行性以及效果。
方法
对1999年1月至2004年12月5年中115例早发型子痫前期病例进行研究,所有病例均满足孕34周前入院并能在本院住院直至分娩,入院前或入院时已确诊为子痫前期,且无妊娠合并慢性高血压、慢性肾炎、肾病综合征等条件。以延长8天为标准分为A组(延长小于8天)和B组(延长8天及以上),有67例归入A组(双胎8例,胎儿数75例),48例归入B组(双胎10例,三胎1例,胎儿数60例)。观察孕妇并发症及围产儿预后。
结果
1.2组孕妇产次、胎数、入院孕周、舒张压血压最高值、24小时尿蛋白定
ObjectiveTo explore the feasibility and efficacy of expectant management in early onset preeclampsia.Method115 cases of early onset preeclampsia in 5 years (between January 1999 to December 2004) were studied. All the cases were admitted before 34 gestational age and diagnosed as preeclampsia before or at that time. There is no chronic hypertension, chronic nephritis or nephrotic syndrome before pregnancy. Two groups were classified by prolonging 8 days as Group A (less than 8 days, sixty-seven cases including eight twins, and seventy-five fetus) and Group B (8 or more days, forty-eight cases including ten twins and one triplets, and sixty fetus). Maternal complications and perinatal prognosis were observed.Results1. There is no significant difference in parity, numbers of fetus, gestational age of admission, the highest level of diastolic pressure and the ratio of urine protein in twenty-four hours between the two groups (P>0.05). But maternal age and the
highest level of systolic pressure were statistically different(P=0.004,0.005).2. There is no significant difference in the using of magnesium sulfate, decompression drugs and nutrition supporting (P>0.05). But the days of magnesium sulfate using and the using of dexasone were statistically different (P<0.001).3. The mean days of prolongation were 8.2 days in all the cases, 3.4 days in Group A, 14.8 days in Group B, with significant difference between them (P<0.001).4. There were no significant difference between maternal major complications including hypoproteinemia, hepatic dysfunction, renal dysfunction, anemia, thrombocytopenia, placental abruption, HELLP syndrome and eclampsia(P>0.05).5. There gestational age of delivery (31.8VS 33.2, P<0.001) and birth weight (1583.4VS 1811.2 g, P=0.028) were significantly different.6. Perinatal death was nineteen (14.1%) including fourteen fetal death (thirteen in group A and one in group B with significantly different, P=0.003) and five neonate death (one of twins and two single fetal in group A;one twins in group B without significant difference, P=0.839).7. There was no significant difference in perinatal complications such as premature labor, neonatal asphyxia, neonatal respiratory distress syndrome, fetal growth restriction, transient tachypnea, hyperbilinibinemia, neonatal malformation between the two groups (P>0.05).Conclusions1. Expectant management is feasible and effective in early onset preeclampsia. hi the balance of maternal-fetal condition, expectant management can prolong gestation age and get better prenatal prognosis.2. It is the critical time that the first twenty-four hours after admission. Dexasone
could be used to prompt the maturity of fetal lung in this period and decision could be made to continue expectant management or terminate immediately according to the situation.3. It is of vital importance to monitor maternal and fetal situation intimately in the course of expectant management, which could make accurate judgment in time and deal with any omen properly to avoid serious maternal complications and fetal death.4.Early onset preeclampsia should be deal with in tristeranty hospital. Sufficient neonatal intensive care unit appliance and serve would show positive effect in reducing neonatal complications.
引文
1 乐杰,谢幸,丰有吉,主编.妇产科学.第六版.北京:人民卫生出版社,2004,97-106.
2 PATTINSON RC, ODENDAAL, DU TOIT R. Conservative management of severe proteinuric hypertension before 28 week'gestation. S Afr Med J, 1988,73:516-518.
3 JENKINS SM, HEAD BB, HAUTH JC. Severe preeclampsia at <25 weeks of gestation: maternal and neonatal outcomes. Am J Obstet Gynecol, 2002,186: 790-5.
4 MARTIN TR, TUPPER WR. The managerment of severe toxemia in patients at less than 36 weeks'gestation. Obstet Gyneeol,1979,54:602-605.
5 VISSER W, WALLENBURG HC. Maternal and perinatal outcome of temporizing management in 254 consecutive patients with severe pre-eclampsia remote from term [J]. Eur J Obstet Gynecol Reprod Biol,1995,63:147-154.
6 VISSER W, WALLENBURG HC. Temporising management of severe preeclampsia with and without HELLP syndrome. Br J Obstet Gynaecol,1995,102:111-117.
7 HALL DR, ODENDAAL HJ,STEYN DW, et al. Expectant management of early onset, severe pre-eclampsia: maternal outcome. BJOG, 2000, 107(10): 1252-1257.
8 Sehiff E, Friedman SA, Mercer BM, Sibai BM. Fetal lung maturity is not accelerated in preeclamptic pregnancies. Am J Obstet Gynecol 1993;169:1096-101.
9 Crowley P. Antenatal eorticosteroid therapy: a recta-analysis of the randomized trials,1972 to 1994. Am J Obstet Gynecol 1995;173:322-35.
10 Amorin MMR, Santos LC, Faundes A. Corticosteroid therapy for prevention of respiratory distress syndrome in severe preeclampsia. Am J Obstet Gynecol 1999;180:1283-8.
11 Gray PH, Jones P, O'Callaghan MJ Maternal antecedents for cerebral palsy in extremely preterm babies: a case-control study. Dev Med Child Neurol 2001;43:580-585.
12 Salokorpi T, Sajaniemi N, Hallback H, Kari A, Rata H, von Wendt L. Randomized study of the effect of antenatal dexamethasone on growth and development of premature children at the corrected age of 2 years. Acta Paediatr 1997;86:294-298.
13 HALL DR, ODENDAAL HJ,STEYN DW, et al. Expectant management of early onset, severe pre-eclampsia: maternal outcome. BJOG,2000,107:1252-1257.
14 SIBAI BM, MERCER B, SARINOGLU C. Severe preeclampsia in the second trimester: recurrence risk and long-term prognosis. Am J Obstet Gynecol,1991,165:1408-1412.
15 Haddad B, Deis S, Goffinet F.Maternal and perinatal outcomes during expectant management of 239 severe preeclampsitic women between 24 and 33 week' gestation. Am J Obstet Gynecol2004;190:1590-7.
16 Vigil-De Gracia P, Montufar-Rueda C, Ruiz J. Expectant management of severe preeclampsia and preeclampsia superimposed on chronic hypertension between 24 and 34 weeks'gestation. Eur J Obstet Gynecol Reprod Biol 2003;107:24-7.
17 Odendaal HJ, Pattinson RC, Bam R, Grove D, Kotze TJ. Aggressive or expectant management for women with severe preeclampsia between 28-34 weeks gestation: a randomized controlled trial. Obstet Gynecol 1990;76:1070-1075.
18 Sibai BM, Mercer BM, Schiff E, Friedman SA. Aggressive versus expectant management of severe preeclmapsia at 28 to 32 week's gestation: a randomized controlled trial. Am J Obstet Gynecol 1994;171:818-822.
19 SIBAI. Magnesium sulfate prophylaxis in preeclampsia: evidence from randomized trials. Clin Obstet Gynecol. 2005,48:478-88.
20 HADDAD B, SIBAI BM.Expectant Management of Severe Preeclampsia: Proper Candidates and Pregnancy Outcome. Clin Obstet Gynecol, 2005,48:430-440.
21 金丽萍,贾晓芳,戴吉茹等.子痫35例临床分析.首都医科大学学报.2004,25:397-399.
22 Bolte AC, van Eyck J, Kanhai HH, et al. Ketanserin versus dihydralazine in the management of severe early-onset preeclampsia: Maternal outcome. Am J Obstet Gynecol 1999;180:371-7.
23 yon Dadelszen P, Magee LA. Antihypertensive medications in management of gestational hypertension-preeclampsia. Clin Obstet Gynecol,2005;48:441-59.
24 Withagen MIJ, Visser W, Wallenburg HCS. Neonatal outcome of temporizing treatment in early-ouset preeclampsia. Eur J Obstet Gynecol Reprod Biol 2001;94:211-215.
25 Withagen MIJ, Wallenburg HCS, Steegers EAP, Hop WCJ, Visser W. Morbidity and development in childhood of infants born after temporizing treatment of early onset pre-eelampsia. BJOG, 2005;112:910-914.
26 Churchill D, Duley L. Interventionist versus expectant care for severe preeclampsia before term [Coehrane review]. In: The Cochrane Library, Issue 4. Oxfore: Update Software,2004:CD003106.
27 WILIN AG, SAADE GR. MATTAR F, et al. Predictor of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks gestation. Am J Obstet Gynecol,2000,182:607-611.
2 PATTINSON RC, ODENDAAL, DU TOIT R. Conservative management of severe proteinuric hypertension before 28 week'gestation. S Afr Med J, 1988,73:516-518.
3 JENKINS SM, HEAD BB, HAUTH JC. Severe preeclampsia at <25 weeks of gestation: maternal and neonatal outcomes. Am J Obstet Gynecol, 2002,186: 790-5.
4 MARTIN TR, TUPPER WR. The managerment of severe toxemia in patients at less than 36 weeks'gestation. Obstet Gyneeol,1979,54:602-605.
5 VISSER W, WALLENBURG HC. Maternal and perinatal outcome of temporizing management in 254 consecutive patients with severe pre-eclampsia remote from term [J]. Eur J Obstet Gynecol Reprod Biol,1995,63:147-154.
6 VISSER W, WALLENBURG HC. Temporising management of severe preeclampsia with and without HELLP syndrome. Br J Obstet Gynaecol,1995,102:111-117.
7 HALL DR, ODENDAAL HJ,STEYN DW, et al. Expectant management of early onset, severe pre-eclampsia: maternal outcome. BJOG, 2000, 107(10): 1252-1257.
8 Sehiff E, Friedman SA, Mercer BM, Sibai BM. Fetal lung maturity is not accelerated in preeclamptic pregnancies. Am J Obstet Gynecol 1993;169:1096-101.
9 Crowley P. Antenatal eorticosteroid therapy: a recta-analysis of the randomized trials,1972 to 1994. Am J Obstet Gynecol 1995;173:322-35.
10 Amorin MMR, Santos LC, Faundes A. Corticosteroid therapy for prevention of respiratory distress syndrome in severe preeclampsia. Am J Obstet Gynecol 1999;180:1283-8.
11 Gray PH, Jones P, O'Callaghan MJ Maternal antecedents for cerebral palsy in extremely preterm babies: a case-control study. Dev Med Child Neurol 2001;43:580-585.
12 Salokorpi T, Sajaniemi N, Hallback H, Kari A, Rata H, von Wendt L. Randomized study of the effect of antenatal dexamethasone on growth and development of premature children at the corrected age of 2 years. Acta Paediatr 1997;86:294-298.
13 HALL DR, ODENDAAL HJ,STEYN DW, et al. Expectant management of early onset, severe pre-eclampsia: maternal outcome. BJOG,2000,107:1252-1257.
14 SIBAI BM, MERCER B, SARINOGLU C. Severe preeclampsia in the second trimester: recurrence risk and long-term prognosis. Am J Obstet Gynecol,1991,165:1408-1412.
15 Haddad B, Deis S, Goffinet F.Maternal and perinatal outcomes during expectant management of 239 severe preeclampsitic women between 24 and 33 week' gestation. Am J Obstet Gynecol2004;190:1590-7.
16 Vigil-De Gracia P, Montufar-Rueda C, Ruiz J. Expectant management of severe preeclampsia and preeclampsia superimposed on chronic hypertension between 24 and 34 weeks'gestation. Eur J Obstet Gynecol Reprod Biol 2003;107:24-7.
17 Odendaal HJ, Pattinson RC, Bam R, Grove D, Kotze TJ. Aggressive or expectant management for women with severe preeclampsia between 28-34 weeks gestation: a randomized controlled trial. Obstet Gynecol 1990;76:1070-1075.
18 Sibai BM, Mercer BM, Schiff E, Friedman SA. Aggressive versus expectant management of severe preeclmapsia at 28 to 32 week's gestation: a randomized controlled trial. Am J Obstet Gynecol 1994;171:818-822.
19 SIBAI. Magnesium sulfate prophylaxis in preeclampsia: evidence from randomized trials. Clin Obstet Gynecol. 2005,48:478-88.
20 HADDAD B, SIBAI BM.Expectant Management of Severe Preeclampsia: Proper Candidates and Pregnancy Outcome. Clin Obstet Gynecol, 2005,48:430-440.
21 金丽萍,贾晓芳,戴吉茹等.子痫35例临床分析.首都医科大学学报.2004,25:397-399.
22 Bolte AC, van Eyck J, Kanhai HH, et al. Ketanserin versus dihydralazine in the management of severe early-onset preeclampsia: Maternal outcome. Am J Obstet Gynecol 1999;180:371-7.
23 yon Dadelszen P, Magee LA. Antihypertensive medications in management of gestational hypertension-preeclampsia. Clin Obstet Gynecol,2005;48:441-59.
24 Withagen MIJ, Visser W, Wallenburg HCS. Neonatal outcome of temporizing treatment in early-ouset preeclampsia. Eur J Obstet Gynecol Reprod Biol 2001;94:211-215.
25 Withagen MIJ, Wallenburg HCS, Steegers EAP, Hop WCJ, Visser W. Morbidity and development in childhood of infants born after temporizing treatment of early onset pre-eelampsia. BJOG, 2005;112:910-914.
26 Churchill D, Duley L. Interventionist versus expectant care for severe preeclampsia before term [Coehrane review]. In: The Cochrane Library, Issue 4. Oxfore: Update Software,2004:CD003106.
27 WILIN AG, SAADE GR. MATTAR F, et al. Predictor of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks gestation. Am J Obstet Gynecol,2000,182:607-611.