| Objective:Preeclampsia-eclampsia,especially early onset severe preeclampsia is a leading cause of maternal and fetal morbidity and mortality. Despite extensive study, the etiology of preeclampsia is poorly understood and only some hypothesizes contributing to the development of preeclampsia. We should pay more attentions to the prevention and management to the preeclampsia–eclampsia, especially early onset severe preeclampsia. Our purpose was to explore the impacts of early clinical intervention and expectant treatment in hospital on the perinatal outcomes of severe early onset preeclampsia.Methods:144 cases with early onset severe preeclampsia (<34 gestational weeks) admitted to and delivered in Teng zhou Central People's Hospital from January 2007 to December 2010 were analyzed in this study. They were divided into two groups according to whether or not conducting regular health care during pregnancy and clinical intervention. We selected 69 cases who conducted regular health care during pregnancy before admitted to hospital, detected early warning signals of preeclampsia after 20 gestational weeks and accepted clinical intervention as study group. The standard warning signals of preeclampsia were as follows:①Prehypertension: systolic pressure 130～140 mmHg (1mmHg=0.133kPa), or diastolic pressure 81～89 mmHg;②Excessive weight increase: weekly weight gain>0.5kg in third trimester;③Edema: still exists after the break and gradually aggravates;④Hypoproteinemia. At the same time, 75 cases who had not conducted regular health care during pregnancy and refused clinical intervention were as control group. Maternal and neonatal outcomes were compared between the two groups.Results:1.General information: The average age at onset of study group was (29.81±4.56 ) years, while that of control group was (30.23±3.25)years. The difference was not statistically significant (P>0.05). The cases of multipara in control group (24/75) were significantly higher than the cases in study group (11/69). The differences were statistically significant (P<0.05). The cases of medical history with preeclampsia in study group (6/69) were similar to the cases in control group (5/75). There was no significant difference (P>0.05).2.Blood pressure, onset gestational age, expectant treatment time after admitted to hospital and gestational weeks of delivery: Systolic pressure (161.14±14.701)mmHg and diastolic pressure (101.02±9.15)mmHg of study group were significantly lower than that of control group, which respectively were (170.07±15.47)mmHg, (108.39±11.05)mmHg. The differences were statistically significant (respectively, P<0.05). The average onset gestational age of study group was (31.83±2.57 )weeks, while that of control group was (30.05±1.64) weeks. Although the average onset gestational age of study group was later than that of control group, there was no statistical significance (P>0.05). The average expectant treatment time of study group (11.23±6.89) days was longer than that of control group (8.91±3.45)days, the difference was statistically significant. The average gestational weeks of study group were (33.46±2.57) weeks, there was significant difference (P<0.05) compared with that of control group (31.23±2.38) weeks.3.Maternal complications: Among the 69 cases of study group, there were 39 cases with hypoproteinemia, 11 cases with renal dysfunction, 7 cases with liver injury, 1cases with HELLP syndrome, 1 case with eclampsia and 1 case with postpartum hemorrhage. Accordingly, the complications emerged in the 75 cases of control group were respectively as follows: hypoproteinemia (45 cases), renal dysfunction (30 cases), liver injury (9 cases), placental abruption (8 cases), eclampsia (6 cases), HELLP syndrome (5 cases), cardiac insufficiency (4 cases), postpartum hemorrhage (4 cases) and DIC with cerebral hemorrhage death (1 case). Compared with the 35 cases in the control group and only 9 cases in the study group had two or more complications. The differences were statistically significant (X2=15.67, P<0.05), and suggested that the patients'condition of control group were much more serious than that of study group. Renal dysfunction, as well as the incidence of eclampsia and placental abruption of those two groups were compared, and the differences were statistically significant (P<0.05).4. Perinatal outcomes: Among the 69 cases perinatal fetus in study group, there were 6 cases with fetal growth restriction, 8 cases with neonatal asphyxia, 9 cases with neonatal death, 2 cases with intrauterine death and 1 case with requiring induction of labor. Accordingly, the perinatal outcomes in the 75 cases perinatal fetus of control group were respectively as follows: fetal growth restriction (16), neonatal asphyxia (20 cases), neonatal death (16 cases), intrauterine death (5 cases), and requiring induction of labor (3 cases). The rate of fetal growth restriction of study group (8.69%) was significantly lower than that of control group (21.33%), the difference was statistically significant (P<0.05).The rate of neonatal asphyxia of study group (11.59%) was significantly lower than that of control group (26.67%), the difference was statistically significant (P<0.05). Similarly, the neonatal and perinatal mortality of study group (130.40‰,173.90‰) were obviously lower than that of control group (213.30‰,320.00‰), the differences were statistically significant (P<0.05). The average weight of neonate was (1750.84±584.68)g in study group and (1400.22±585.36)g in control group, and the difference was statistically significant (P<0.05). The average hospital stay of study group was (33.23±9.06)days, and that of control group was (46.25±9.52)days, the differences between the two groups were statistically significant (P<0.05).Conclusions:Regular prenatal care contributes to the early detection of early warning signals of preeclampsia. Proper clinical intervention and expectant treatment may delay the onset time of early onset severe preeclampsia, prolong gestational weeks, reduce prenatal mortality and the incidence of maternal complications, and shorten neonate hospital stays as well. |
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