| Background Preeclampsia is closely related to the obstetrics and gynecology field because it is closely related to the adverse consequences of the mother and fetus.PE manifests as symptoms of blood pressure rise beyond the normal range starting at 20 weeks of pregnancy,and it also causes functional problems in different organs throughout the body.The presence or absence of proteinuria is not a rigid indicator.PE is a dynamic disease with progressive or rapid progression.In order to avoid neglect of the condition and better attract the attention of clinicians and expectant mothers,the latest clinical guidelines no longer have a"mild"preeclampsia diagnosis,And"severe"preeclampsia indicates that the patient's condition has progressed to a serious stage,and the body's multiple organ functions have been damaged.Common manifestations are:Conscious discomfort-severe headache,vision loss,abdominal headache,edema;biochemical abnormalities-AST,ALT,PLT,CR.Currently,the prevalence of PE with pregnancy in the world is 4.6%,and3.4%of pregnant women with PE in the United States.In developing countries,the incidence of PE is 1.8-16.7%[1].In China,PE is the second major cause of perinatal mortality.The difference in prevalence among countries also reflects the level of perinatal medical and health work in this area,and on the other hand,it also serves as a test indicator for judging the quality of local medical and health care.Today,the pathogenesis of PE is still the goal that obstetricians and gynecologists need to continue to develop.Lhasa is known as the Sunshine City and the highest settlement in the world.Many people will have high discomfort when they first come here,because the oxygen content here is only 3/5 of the sea level oxygen content.Checking the data shows that the incidence of PE in the plateau area is significantly higher than that in the plain area,especially SP.Because the factors of perinatal diseases caused by the release of PE placenta are still complex and there is no breakthrough point,the current focus of PE is to prevent maternal syndrome.SP has obvious clinical characteristics and prominent biochemical indicators,which is convenient for us to discuss and analyze.Objective By collating the data,comparing the SP patient data and biochemical indicators admitted in this period,the similarities and differences between the two subtype groups and whether the differences were significant were analyzed.The two subtype groups were analyzed from the perspective of mother and infant:maternal-basic personal data,complications,pregnancy termination,and perinatal-outcome status.Preventing the occurrence and development of PE is the core issue.Cases are the most intuitive clinical entry point to explore the differences between the two subtype groups on maternal and infant outcomes,and to understand the characteristics of the disease at a deeper level to make management and treatment more effective.Methods The clinical data of SP patients who were admitted to the obstetrics and gynecology department of the Tibet Autonomous Region People's Hospital from January 2016 to October 2018 were collected.A total of 166 clinical data met the inclusion criteria of this retrospective study.According to the number of weeks of pregnancy,the patients were divided into two groups.Early onset severe preeclampsia?<34W?group met the diagnostic criteria.A total of 88 patients met the criteria.Late-onset severe preeclampsia There were 78 cases in the onset severe pre-eclampsia??34W?group.Statistical methods were used to compare the two groups in terms of general conditions,maternal complications,perinatal outcomes,and methods of terminating pregnancy.Study the differences in the performance of SP patients in Tibet during different gestational weeks.Results 1.Statistical analysis of the general situation and clinical manifestations of the early-onset severe preeclampsia group and the late-onset severe preeclampsia group:the expressions of previous pregnancy history of hypertension in the two groups were 15?17.0%?and2?2.6%?;The gestational week is expressed in days,which is 206.42±22.15,260.82±15.60;the systolic blood pressure at admission is 164.07±17.79,150.83±18.17;the diastolic blood pressure at admission is109.03±16.51,104.06±14.30;The days of conservative treatment until termination of pregnancy were 4.49±6.85 and 1.91±3.16,respectively.The early-onset severe preeclampsia group had significantly higher expression levels of previous pregnancy history of hypertension,gestational age,systolic blood pressure,and diastolic blood pressure than the late-onset group,with statistically significant differences?P<0.05?,while the two groups were in gestational age?years old?,Advanced age??35 years old?,pregnancy,parity,and family history of hypertension were not statistically different.2. Statistical analysis of maternal complications:the number and proportion of cases of placental abruption in the two groups were 10?11.4%?and 2?2.6%?;the expression of fundus lesions was 16?18.2%?and 3?3.8%?;The expression of pleural effusion in the two groups of patients was 16?18.2%?and 3?3.8%?;urine protein at admission was counted as only 3"+",respectively 63?71.6%?and 41?52.6%?);Analysis in accordance with HELLP syndrome?hemolysis,elevated liver enzymes,and low platelets syndrome,HELLP?:13?14.8%?,1?1.3%?;the two subgroups of liver function damage are expressed as:19?21.6%?,5?6.4%?;renal impairment,analysis of the two subtype groups:9?10.2%?,2?2.6%?;analysis that meets the diagnostic criteria for hypoproteinemia:63?71.6%?,39?50%?.Early-onset severe preeclampsia HELLP syndrome,urinary protein"3+",liver and kidney function impairment,hypoproteinemia were significantly higher than late-onset severe preeclampsia,with statistical significance,P<0.05,including urine proteinIt is most common with hypoproteinemia.Placenta implantation occurs less frequently in the statistics of the two subtype groups,and there is no statistical difference.The phenomenon of maternal anemia is very common,but statistical analysis in the two subtype groups shows no significant difference.3. Perinatal outcome analysis:neonatal asphyxia occurred in 36cases?40.9%?in the early-onset severe preeclampsia group and 14 cases?20.5%?in the late-onset severe preeclampsia group;fetal growth restriction occurred The analysis was 25?28.4%?,8?10.3%?;the analysis of occurrence of preterm delivery was 67?76.1%?,44?56.4%?;there were 21 stillbirths in the early-onset severe preeclampsia group,accounting for?23.9%?,There were 9 stillbirths in the late-onset severe preeclampsia group,with an incidence rate of?11.5%?.Except for the comparison of data transferred to the neonatal intensive care unit?NICU?in the two subtype groups,there was no significant difference.The perinatal infants had neonatal asphyxia,fetal growth restriction,premature delivery,stillbirth,etc.The incidence of perinatal infants in the late-onset severe preeclampsia group was lower than that in the early-onset severe preeclampsia group.4.Analysis of different pregnancy termination methods:The data analysis of the two groups of patients with vaginal termination of pregnancy was 25?28.4%?,27?34.6%?,the early-onset group and the late-onset group were 63?71.6%?,51?65.4%?,The two groups have no significant difference in cesarean section and transvaginal termination of pregnancy.Conclusion 1.Patients with a history of pregnancy-induced hypertension are more likely to have early-onset severe preeclampsia.2.Early-onset severe preeclampsia patients are admitted to the hospital during gestational weeks and early gestational weeks of delivery.The hospital admissions and the maternal-infant complications are serious,and the incidence and mortality of maternal-infant complications are high.3. Early-onset severe pre-eclampsia and late-onset severepre-eclampsia neonates are transferred to the NICU crowd,which may be related to the special hypoxic environment in Tibet.4. The time for conservative treatment in Tibet is short,and theearly-onset severe pre-eclampsia is longer in conservative treatment time than the late-onset severe pre-eclampsia.5. The main option for termination of pregnancy in patients withEarly-onset severe pre-eclampsia and late-onset severe pre-eclampsia is cesarean section. |
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