Analysis Of Coagulation Parameters And Maternal And Neonatal Outcomes Of Early Onset Severe Preeclampsia Combined With Fetal Growth Restriction

ObjectivePreeclampsia(PE)is a common type of hypertensive disorder in pregnancy.The prevalence is 2-5%.In 2015,the Chinese Medical Association Obstetrics and Gynecology Branch renewed the diagnosis of preeclampsia,which is based on hypertension.There are any organs or systems affected,with or without proteinuria.Preeclampsia(PE)because of inadequate perfusion of the uterine spiral arterioles,which will result in decreased perfusion of placental,and easily combine with fetal growth restriction(FGR).In recent years,the prevalence of FGR in patients with preeclampsia is increasing.The study found that some patients with FGR gradually develop into PE as the gestational age increases during the second trimester.For the pre-eclampsia classification,the latest Canadian guideline 2014 states that mild preeclampsia was defined as non-severe,and as long as any severe preeclampsia(spee preeclampsia,sPE)performance can be diagnosed as severe one,sPE as one kind of clinical common disease,which has become one of the important causes of perinatal and maternal mortality.And early onset of severe preeclampsia usually occurs before 34 weeks.The pathogenesis of severe preeclampsia is diverse,involving immune,genetic,endothelial cell dysfunction and coagulation dysfunction,which eventually results in increasing resistance of uterine arterial blood flow,inadequate placental perfusion,decreased function and a series of clinical manifestations.The paper is going to explore the pathogenesis of sPE about coagulation markers.The blood of normal late pregnancy shows a tendency of increaseing coagulation,and chronic local intravascular coagulation occurs in the placenta,which is the so-called physiological hypercoagulation state during pregnancy.Due to vascular endothelial cell damage of the patients with severe preeclampsia,whose blood has a dysregulated balance of coagulation and fibrinolysis and anticoagulation,namely the prethrombotic state.Some patients with sPE develop to combine with FGR,and some do not,suggesting that the pathogenesis of the two is not the same.The coagulation mechanism is mainly monitored from the following indicators.Protein S,protein C,and antithrombin III(AT-III)are important anticoagulants in the blood,mainly affecting the coagulation and fibrinolytic system and exerting their anticoagulant and antithrombotic effects.D-dimer is a cross-linked protein product that can better reflects the coagulation state of the body.The differences in the pathogenesis of the disease are investigated by comparing the clinical coagulation parameters of patients with or without FGR combined sPE.Clinical treatment of sPE patients with FGR are always controversial.The earlier of the early onset severe preeclampsia disease occurs,the heavier the disease will be,the lower the ability of the fetus will survive,and the selective expectation on the premise of ensuring the safety of mother and child.Treatment,to extend the gestational age as much as possible,which will improve the survival rate of newborns,thereby improving premature infants due to immature mortality.Although fetal growth restriction is not a contraindication to early onset of severe preeclampsia expectant treatment,which will often be terminated due to factors such as placental dysplasia and fetal risks,so whether early severe severe preeclampsia with fetal growth restriction is truly suitable for expectant treatment,and if which will increase the complications of the mother and affect the fetal survival rate is still pending.This study intends to retrospectively analyze our hospital's early onset of severe preeclampsia with fetal growth restriction coagulation parameters,expectation of treatment of maternal and child outcomes,to further clarify the clinical features of the disease,to provide reference for optimizing the maternal and infant outcomes.Materials and methods1 Research objects and groupingA total of 158 cases of severe early preeclampsia who were hospitalized and delivered in our hospital from January 2016 to June 2017 were selected.The study group consisted of 57 cases of severe preeclampsia combined with fetal growth restriction,and the control group consisted of 101 cases of early onset severe preeclampsia,and 45 cases of normal pregnant women without EOSP final term delivery at the same gestational age.All gestational weeks were between 28 and 34.The expected treatment was cesarean section termination.Every pregnant only has one baby.2 Research Methods2.1 Retrospective analysising maternal clinical datas,collecting general conditions of patients,blood coagulation indicators after admission and fetal umbilical artery systolic velocity/diastolic velocity(S/D),comparing EOSP,EOSP with FGR and normal coagulation indicators of pregnant women at the same gestational age.2.2 Expectant treatment is given to patients with EOSP combined with FGR and uncombined FGR.Expectant treatments include sedation,antispasmodic,antihypertensive,etc.Promoting fetal lung to be mature and terminate pregnancy if necessary.And then,expectant treatment is that the pregnancy is not terminated within24 hours after admission.The clinical data of the patients were collected and the expectation of post-treatment maternal complications and neonatal outcomes were compared between the study group and the control group.The differences in neonatal complications were also analyzed.3 Statistical methodsThe data were analysed using SPSS 18.0 software.Measured data were expressed as x±s or median(P25,P75).Data between groups were compared with independent sample test or non-parametric test,and the rate(%)was used to represent counting data.To test the comparative value using?~2 test.Difference with P<0.05 were considered to be statistically significant,difference with P<0.017 were considered to be statistically significant between the three groups.4 Results4.1 Comparison of Coagulation Parameters in Study Group,Control Group and Health Group(1)The protein S and AT-III in the study group were lower than those in the normal group,and the D-dimer was higher than the normal group(P<0.017).The protein S and AT-III in the control group were lower than those in the normal group.D-dimer was higher than normal group,and the difference was statistically significant(P<0.017).There was no significant difference in protein C between the three groups(P>0.05).(2)There was no significant difference in protein S,protein C,D-dimer and antithrombin III between the two groups(P>0.017).4.2 The outcomes of the expected treatment in the study and control groups(1)The S/D value in the study group was higher than that in the control group(P<0.05),and the difference was statistically significant.There was no significant difference between the study group and the control group in terms of gestational age,days of hospitalization,and gestational age(P>0.05).(2)There was no significant difference in maternal complications(retinal edema,pleural effusion,ascites,placental abruption,acute left heart failure,HELLP syndrome)between the group and the control group in expectant treatment(P>0.05).(3)The incidence of cardiac dysplasia was higher than that of the control group(P<0.05),and the weight of the newborns was lower than that of the control group(P<0.05).The incidence of termination of pregnancy due to fetal distress was higher than that of the control group(P<0.05).The difference was statistically significant.5 Conclusion5.1 The blood of EOSP patients with or without FGR is in a hypercoagulable state,umbilical blood flow abnormalities in EOSP patients with FGR may indicates an exacerbation of EOSP;5.2 The incidence of neonatal cardiac insufficiency and termination of pregnancy due to fetal distress are higher of expectant treatment in patients with EOSP combined with FGR.