| ObjectiveTo explore the correlation between different gestational weeks at onset of severe preeclampsia and time of expectant treatment,pregnancy outcomes.To observe the influence of different timing of pregnancy termination on mother-infant outcomes in patients with early-onset severe preeclampsia.MethodsThe clinical data of 221 severe preeclampsia patients in accordance with the inclusion criteria from January 2013 to May 2017 in the department of obstetrics in Sichuan Provincial People’s Hospital was analyzed retrospectively.1.A total of 221 patients with early onset severe preeclampsia were divided into early-onset severe preeclampsia group(n=89,gestational onset weeks of less than 34 weeks)and late-onset preeclampsia group(n=132,gestational onset weeks equaling to or more than 34 weeks).The time of expectant treatment,maternal and perinatal complications were analyzed.2.A total of 89 early-onset severe preeclampsia cases were subdivided into group A with gestational termination weeks of less than 32 weeks,group B,with gestational termination weeks equaling to or more than 32 to less than 34 weeks,and group C with gestational weeks equaling to or more than 34 weeks.The time of expectant treatment,maternal complications and perinatal complications were analyzed.ResultsMother-infant outcomes of early-onset and late-onset severe preeclampsia patients1.The early-onset severe preeclampsia group had significantly higher average time of expectant treatment[(6.03±5.31)d vs.(1.91±1.40)d,P<0.001],incidence rate of transferring into ICU(21.35%vs.7.58%,P<0,05)and total hospital stay[(12.35 ± 8.82)d vs.(6.30 ± 2.94)d,P<0.001]than late-onset severe preeclampsia group,but the duration of ICU showed no statistical difference between two groups(P>0.05).2.Eclampsia,HELLP syndrome,pleural-celiac effusion and renal function damage only occurred in the early-onset severe preeclampsia group.The early-onset severe preeclampsia group had higher incidence rates of placental abruption,postpartum hemorrhage and heart failure(7.87%vs.1.52%,6.74%vs.4.55%,4.49%vs.3.03%)than late-onset severe preeclampsia group,but significant differences were observed only in placental abruption and pleural-celiac effusion between two groups(P<0.05).3.Only early-onset severe preeclampsia group presented fetal distress in uterus,fetal death in uterus,and perinatal death,and significant differences in fetal distress in uterus,perinatal death rate,neonatal asphyxia,smaller gestational age than normal and treatment rate of t NICU transfer between two groups(P<0.05).4.Cesarean section was the most important way to terminate pregnancy in patients with severe preeclampsia.Mother-infant outcomes of early-onset severe preeclampsia patients with different timing of pregnancy termination1.The average expected time of treatment in group A,B,C was(3.24 ± 3.05)d,(7.00 ± 4.83)d,and(6.52 ± 5.94)d,respectively,and group B was the longest,followed by group C,and group A was the shortest.There was significant difference in average expected time of treatment in three groups(P<0.05),and significant differences were found in A,B groups,as well as A,C groups(P<0.0167).2.The incidence rates of placental abruption,pleural-celiac effusion,postpartum hemorrhage,eclampsia,renal impairment,heart failure,liver impairment were 23.53%,17.65%,11.76%,11.76%,11.76%,5.88%,5.88%,respectively,which were significantly higher than that of group B and C.However,a significant difference was observed only in placental abruption in groups A,B,and C(P<0.05).Group C presented HELLP syndrome in one case(2.17%),and eclampsia occurred in groups A and B,with the incidence rate of 11.76%,7.69%,respectively.3.Fetal death in uterus and perinatal death only occurred in group A,and there were significant differences among three groups(P<0.05).The incidence rate of fetal distress in uterus was 29.41%in group A,and there was significant difference in groups A,B and C in incidence rate of fetal distress(P<0.05).And between-group significant differences were seen in groups A and B,A and C(P<0.0167).Rate of neonatal asphyxia and neonates with smaller normal gestational age showed no statistical differences among three groups(P>0.05).A significant difference in incidence rate of transferring into NICU was observed among three groups(P<0.05),and in A and B groups(P<0.0167).4.Transvaginal delivery rate in group A was 35.29%,which was significantly higher than group C,and B,but significant difference was found onlu between groups A and C(P<0.0167).ConclusionsPatients with early-onset severe preeclampsia have longer time of expectant treatment,higher risks of severe mother-infant complications and higher incidence of perinatal death.Cesarean section is the most important way to prevent severe preeclampsia in pregnancy.Once early-onset severe preeclampsia patients with gestational week less than 32 weeks have a poor disease control before 32 gestational week,the expectant treatment time should be shortened and pregnancy expected to terminate to reduce incidence of severe complications,and transvaginal delivery is recommended to decrease surgical trauma if it is permitted.For stable patients with early-onset severe preeclampsia after treatment on admission,timing of pregnancy termination should be prolonged to 32 weeks to reduce the mother-neonate complications and increase the chances of survival rate of neonatal rescue. |
