Screening And Outcome Of Pregnant Women With Hypothyroidism

Objective: Hypothyroidism in pregnancy is the common endocrine dise-ase during pregnancy. In recent years, with domestic and foreign in-depthstudying of this disease and the increasing efforts to screening the thyroidfunction of pregnant women the detection rate of pregnant women withhypothyroidism is increasing, the abortion, a variety of adverse pregnancyoutcomesthe and fetal spirit, the impact of the nervous system is more andmore attentioned. However at home and abroad there is a dispute whetherthyroid function screening in all early pregnant women.The guide of Chinaalso not require screening thyroid function in all pregnant women. In thisstudy, screen thyroid function of early pregnant women,given the patientscombined with hypothyroidism levothyroxine replacement therapy. Analyzethe influence of thyroid function on threatened abortion, the predictive valueof threatened abortion and the influence of pregnancy with hypothyroidism onpregnancy outcome.Methods: Prospective analysis2025patients during early pregnancy thefirst time diagnosis and treatment in the maternity clinic of The FourthHospital of Hebei Medical University in October2010-January2013. All ofthem cubit venous blood sampling about4ml send to our clinical laboratory.Threatened abortion patients were detected progesterone (P) and thyroidstimulating hormone (TSH), free thyroxine (FT4); other patients in earlypregnancy with detection of TSH, FT4. Given progesterone intramus-cularand oral dydrogesterone therapy for the patients with threatened abortion andlow level of progesterone, given levothyroxine replacement therapy forpatients with hypothyroidism,and observe the outcome. The application SPSS13.0statistical software for statistical analysis using the Mann-Whitney Urank sum test, X2test, the receive operating characteristic curve(ROC) statis-tical methods to screen thyroid function of early pregnant women, given the patients combined with hypothyroidism levothyroxine replacement therapy.Observe the incidence of the hypothyroidism in pregnancy; analyze therelationship in thyroid function and threatened abortion and progesteronevalue, calculate the predictive value of serum progesterone for threatenedabortion, compare miscarriage success rate between merge hypothyroidismwith normal thyroid function in patients with threatened abortion, analyze thepregnancy outcome of pregnant women with hypothyroidism. P＜0.05wasconsidered statistically significant.Results: This study were screened women in early pregnancy2025cases,the incidence rate of hypothyroidism in pregnancy was5.8%(117/2025). In2025cases of early pregnancy women, with normal thyroid function are1908cases-the group of normal thyroid function, which threat-ened abortionpatients189(9.91%) cases and normal pregnancy1719(90.09%) patients;hypothyroidism117patients-the group of hypothyroidism,which threatenedabortion patients58(49.57%) cases, normal pregnancy59(50.43%) patients.comparison between the two groups have a significant difference (P＜0.05).Threatened abortion patients (247cases)were divided into the normal thyroidfunction group(189cases) and hypothyroidism group(58cases) according to thethyroid function screening results, comparison between the two groups haveno significant difference in progesterone values before treatment(P＞0.05).Threatened abortion patients(247cases) were divided into defend successfulgroup (187cases) and inevitable abortion group (60cases) according towhether miscarriage successfully, comparison between the two groups for thefirst time inspection progesterone value have significant difference(P＜0.05).Do receive operating characteristic curve(ROC) with progesterone values,progesterone value15.885ng/ml as predictive value in patients with threatenedabortion miscarriage treatment success. Miscarriage success in the normalthyroid function group (189cases)145cases (76.72%), miscarriage failed44cases (23.28%), in hypothyroidism group(58cases), miscarriage success42cases (72.41%), miscarriage failed16cases (27.59%). compare the miscarri-age success rate between two groups have no significant difference (P＞0.05). during the research108patients with hypothyroidism childbirthde,comparison between hypothyroidism treatment group and hypo-thyroidismuntreated group, the incidence of severe anemia, pregnancy-inducedhypertension and pre-eclampsia, premature rupture have a significantdifference (P＜0.05), the neonatal birth weight, Apgar score1minute afterbirth have significant difference(P＜0.05), the mode of delivery have nosignificant difference (P＞0.05).Conclusion: This study were screened women in early pregnancy2025cases in October2010-January2013, the incidence rate of hypothyroidism inpregnancy was5.8%. The incidence rate of hypothyroidism is higher in preg-nancy women with hypothyroidism and in patients with threatened abortionincidence than normal pregnancy. comparison between the two groups haveno significant difference in progesterone values. Serum progesterone levels inthe prediction of the pregnancy outcome of threatened abortion has a verygood effect, progesterone value15.885ng/ml as predictive value in patientswith threatened abortion miscarriage treatment success, progesterone value＜15.885ng/ml, defend less likely success; Progesterone value＜15.885ng/ml,defend more likely to succeed. Compare the miscarriage success rate betweenthe normal thyroid function group and hypothyroidism group have no sig-nificant difference. Comparison with the pregnant women with hypothyro-idism treated, the pregnant women untreatment have a high incidence ofsevere anemia, pregnancy-induced hypertension and pre-eclampsia；but thedelivery of neonatal birth weight,1minute Apgar score after birth are lower;pregnant women with hypothyroidism had no effect on the mode of delivery.