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中华产科急救电子杂志

中华产科急救电子杂志 ›› 2021, Vol. 10 ›› Issue (02) : 82 -88. doi: 10.3877/cma.j.issn.2095-3259.2021.02.005

论著

妊娠期高血压疾病剖宫产孕妇再次妊娠发生早发型子痫前期的临床分析
毕石磊1, 张丽姿2, 贾金平3, 温穗文4, 王志坚2, 曹引丽5, 王少帅6, 徐晓燕6, 冯玲6, 赵先兰7, 赵扬玉8, 朱启英9, 漆洪波10, 张兰珍11, 李宏田12, 杜丽丽1,†(), 陈敦金1,†()   
  1. 1. 广东省广州医科大学附属第三医院妇产科，广东省产科重大疾病重点实验室，广州重症孕产妇救治中心，510150
    2. 广东省南方医科大学南方医院妇产科，510515
    3. 广州市花都区妇幼保健院，510800
    4. 广东省广州医科大学附属第六医院-清远市人民医院妇产科，511500
    5. 西安市西北妇女儿童医院，710003
    6. 武汉市华中科技大学同济医学院附属同济医院妇产科，430030
    7. 郑州市郑州大学第一附属医院妇产科，450052
    8. 北京大学第三医院妇产科，100191
    9. 乌鲁木齐市新疆医科大学第一附属医院妇产科，830054
    10. 重庆医科大学附属第一医院妇产科，401122
    11. 广东省广州医科大学附属第二医院妇产科，510260
    12. 北京国家卫生健康委员会生育健康重点实验室，100191
  • 收稿日期:2021-02-13 出版日期:2021-05-18
  • 通信作者: 杜丽丽, 陈敦金
  • 基金资助:
    国家自然科学基金(81830045和81971415); 国家重点研发计划资助(2016YFC1000405, 2017YFC1001402和2018YFC1004104); 广东省自然科学基金(2021A1515011039)

Clinical characteristics of pregnant women complicated with early onset preeclampsia with prior cesarean section due to hypertensive disorders of pregnancy

Shilei Bi1, Lizi Zhang2, Jinping Jia3, Suiwen Wen4, Zhijian Wang2, Yinli Cao5, Shaoshuai Wang6, Xiaoyan Xu6, Ling Feng6, Xianlan Zhao7, Yangyu Zhao8, Qiying Zhu9, Hongbo Qi10, Lanzhen Zhang11, Hongtian Li12, Lili Du1,†(), Dunjin Chen1,†()   

  1. 1. Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou Medical Center for Critical Pregnant Women, Guangzhou 510150, China
    2. Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
    3. Department of Obstetrics and Gynecology, Guangzhou Huadu District Maternal and Child Health Hospital, Guangzhou 510800, China
    4. Department of Obstetrics and Gynecology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People′s Hospital, Guangzhou 511500, China
    5. Department of Obstetrics and Gynecology, Northwest Women′s and Children′s Hospital, Xian 710003, China
    6. Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
    7. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
    8. Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
    9. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
    10. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 401122, China
    11. Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
    12. Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
  • Received:2021-02-13 Published:2021-05-18
  • Corresponding author: Lili Du, Dunjin Chen
  • About author:
    * Bi Shilei and Zhang Lizi are the first authors who contributed equally to the article. Bi Shilei, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China; Zhang Lizi, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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引用本文：

毕石磊, 张丽姿, 贾金平, 温穗文, 王志坚, 曹引丽, 王少帅, 徐晓燕, 冯玲, 赵先兰, 赵扬玉, 朱启英, 漆洪波, 张兰珍, 李宏田, 杜丽丽, 陈敦金. 妊娠期高血压疾病剖宫产孕妇再次妊娠发生早发型子痫前期的临床分析[J]. 中华产科急救电子杂志, 2021, 10(02): 82-88.

Shilei Bi, Lizi Zhang, Jinping Jia, Suiwen Wen, Zhijian Wang, Yinli Cao, Shaoshuai Wang, Xiaoyan Xu, Ling Feng, Xianlan Zhao, Yangyu Zhao, Qiying Zhu, Hongbo Qi, Lanzhen Zhang, Hongtian Li, Lili Du, Dunjin Chen. Clinical characteristics of pregnant women complicated with early onset preeclampsia with prior cesarean section due to hypertensive disorders of pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2021, 10(02): 82-88.

目的

分析既往因妊娠期高血压疾病剖宫产孕妇再次妊娠发生早发型子痫前期的危险因素及母儿围产期结局。

方法

收集2017年1月至12月来自11家三级医院既往因妊娠期高血压疾病剖宫产后再次妊娠的478例孕妇的临床资料，采用Logistic多因素回归分析方法，分析既往高血压类型和再次妊娠的临床特征与早发型子痫前期的相关性，以及早发型子痫前期对母儿围产期结局的影响。

结果

转诊和高血压病史是既往因妊娠期高血压疾病而剖宫产的孕妇再次妊娠发生早发型子痫前期(转诊aOR＝6.085, 95% CI＝2.209～16.759，高血压病史aOR＝28.860, 95% CI＝4.309～193.277)、妊娠期高血压(转诊aOR＝2.912, 95% CI＝1.524～5.567，高血压病史aOR＝14.094, 95% CI＝3.881～51.190)及晚发型子痫前期(转诊aOR＝2.602, 95% CI＝1.325～5.109，高血压病史aOR＝17.755, 95% CI＝4.728～66.671)的危险因素。与血压正常、妊娠期高血压、晚发型子痫前期孕妇相比，早发型子痫前期孕妇住院时间长，转入新生儿重症监护率高(76.5% vs 10.4%, χ2＝133.40；76.5% vs 31.1%, χ2＝26.69；76.5% vs 21.4%, χ2＝41.84，P值均<0.05)。

结论

早发型子痫前期对孕妇及新生儿的影响较大，对高危人群的早期识别和防治具有重要意义。

关键词: 子痫前期, 剖宫产术, 妊娠结局
Objective

To analyze the risk factors and perinatal outcomes of early onset preeclampsia in pregnant women with previous cesarean section due to hypertensive disorders.

Material and Methods

478 pregnant women with prior cesarean section history due to hypertensive disorders of pregnancy from 11 tertiary hospitals between January and December 2017 were recruited. We used multivariate Logistic regression to analyze the relationship between the types of prior hypertensive disorders and the clinical features of pregnancy and early onset preeclampsia. We also analyzed the effects of early onset preeclampsia on maternal and perinatal outcomes.

Results

Referral and history of hypertension were the risk factors for early onset preeclampsia(referral aOR=6.085, 95% CI=2.209-16.759, history of hypertension aOR=28.860, 95% CI=4.309-193.277), gestational hypertension(referral aOR=2.912, 95% CI=1.524-5.567, history of hypertension aOR=14.094, 95% CI=3.881-51.190) and late onset preeclampsia(referral aOR=2.602, 95% CI=1.325-5.109, history of hypertension aOR=17.755, 95% CI=4.728-66.671). Comparing with normal blood pressure, gestational hypertension or late onset preeclampsia, women complicated with early onset preeclampsia had a longer hospital stay, lower neonatal weight, Apgar score, and higher NICU admission rate(76.5% vs 10.4%, χ2=133.40, 76.5% vs 31.1%, χ2=26.69, 76.5% vs 21.4%, χ2=41.84, P<0.05).

Conclusions

Early onset preeclampsia has a great impact on pregnant women and newborns. Earlier identification and prevention for women with high risks of early onset preeclampsia are important.

Key words: Preeclampsia, Cesarean section, Pregnancy outcome
表1 四组孕妇一般情况比较
分组 例数 年龄(岁，±s) 民族[例(%)] 孕前体重(kg，±s) 住院体重(kg，±s) 孕期增重(kg，±s)
汉族 其他
妊娠期高血压 61 33.30±4.69ad 56(91.8)ad 5(8.2) 62.13±10.00ad 74.46±10.84ad 12.33±3.14a*d
早发型子痫前期 68 32.13±5.19b 66(97.1)b 2(2.9) 62.60±7.37b* 74.32±8.74b 11.72±3.66b*
晚发型子痫前期 70 32.64±4.30ce 68(97.1)ce 2(2.9) 63.20±10.60c*e 76.82±11.35c*e 13.62±3.67ce*
对照组 279 31.94±4.51 271(97.1) 8(2.9) 59.87±9.31 73.18±9.75 13.31±3.80
χ2值   5.97 4.39 11.46 6.58 16.04
P值   0.113 0.222 <0.05 0.087 <0.05
分组 例数 BMI(kg/m2，±s) 孕次(次，±s) 产次(次，±s) 流产史[例(%)] 流产次数(次，±s) 剖宫产次数(次，±s)
妊娠期高血压 61 28.68±3.61ad 3.25±1.18ad 1.15±0.40ad 40(65.6)ad 1.10±1.11ad 1.13±0.39ad
早发型子痫前期 68 28.40±3.16b 3.43±1.24b* 1.24±0.52b 46(67.6)b 1.19±1.16b 1.21±0.48b*
晚发型子痫前期 70 29.68±3.82c*e* 3.21±1.17ce 1.23±0.49c*e 43(61.4)ce 0.99±0.99ce 1.20±0.50ce
对照组 279 28.57±3.30 3.10±1.18 1.11±0.34 164(58.8) 1.00±1.11 1.09±0.31
χ2值   6.03 5.04 6.45 2.37 1.83 7.02
P值   0.11 0.169 0.092 0.499 0.61 0.071
分组 例数 距上次剖宫产(月，±s) 辅助生殖受孕[例(%)] 转诊[例(%)] 胎儿性别[例(%)] 糖尿病[例(%)]
男 女
妊娠期高血压 61 63.30±33.44ad 2(3.3)ad 24(39.3)a*d* 33(57.9)ad 24(42.1) 17(31.5)ad
早发型子痫前期 68 68.84±42.83b 1(1.5)b 40(58.8)b* 39(58.2)b 28(41.8) 10(15.4)b*
晚发型子痫前期 70 67.94±35.76ce 2(2.9)ce 21(16.3)c*e* 44(62.9)ce 26(37.1) 17(25.8)ce
对照组 279 72.03±38.70 7(2.5) 44(15.8) 153(56.9) 116(43.1) 68(28.7)
χ2值   3.61 0.482 57.842 0.817 5.409
P值   0.307 0.923 <0.05 0.845 0.144
分组 例数 高血压病史[例(%)] 上次妊娠高血压类型[例(%)] 孕周(周，±s)
妊娠期高血压 子痫前期(含慢高合并子痫前期) 慢性高血压合并妊娠
妊娠期高血压 61 9(14.8)a*d 40(65.6)ad 18(29.5) 3(4.9) 36.15±2.72a*d*
早发型子痫前期 68 12(17.6)b* 42(61.8)b 25(36.8) 1(1.5) 31.16±2.10b*
晚发型子痫前期 70 9(12.9)c*e 44(62.9)ce 25(35.7) 1(1.4) 37.53±1.35ce*
对照组 279 4(1.4) 177(63.4) 100(35.8) 2(0.7) 37.35±2.25
χ2值   35.23 6.758 166.21
P值   <0.05 0.344 <0.05
表2 多因素Logistic回归分析早发型子痫前期的危险因素
分组 转诊 高血压病史
aOR 95% CI aOR 95% CI
妊娠期高血压 2.912 1.524～5.567 14.094 3.881～51.190
早发型子痫前期 6.085 2.209～16.759 28.860 4.309～193.277
晚发型子痫前期 2.602 1.325～5.109 17.755 4.728～66.671
对照组 1   1  
表3 四组孕妇妊娠结局比较
分组 例数 胎盘早剥[例(%)] 胎儿生长受限[例(%)] 阴道试产[例(%)] 产后出血[例(%)] 输血[例(%)] 住院时间(d，±s)
妊娠期高血压 61 0(0)ad 1(1.6)ad* 5(8.2)ad* 1(1.6)ad 4(5.6)ad 7.10±3.45a*d*
早发型子痫前期 68 0(0)b 8(11.8)b* 0(0)b 4(5.9)b 4(5.9)b 8.60±4.37b*
晚发型子痫前期 70 1(1.4)ce 5(7.1)c*e 4(5.7)ce 2(2.9)ce 2(2.9)ce 6.01±3.00ce*
对照组 279 0(0) 3(1.1) 14(5.0) 16(5.7) 10(3.7) 6.29±3.48
χ2值   5.84 21.64 8.12 3.11 1.82 41.61
P值   0.12 <0.05 0.044 0.375 0.611 <0.05
表4 四组新生儿结局比较
分组 例数 新生儿出生体重(g，±s) Apgar评分(分，±s) NICU[例(%)]
1 min 5 min 10 min
妊娠期高血压 61 2848.40±655.92a*d* 9.05±1.73ad* 9.66±1.38ad* 9.74±1.32ad* 19(31.1)a*d*
早发型子痫前期 68 1482.46±596.57b* 7.66±2.66b* 8.68±2.36b* 8.76±2.56b* 52(76.5)b*
晚发型子痫前期 70 3006.29±556.39ce* 8.87±1.77ce* 9.49±1.70c*e* 9.53±1.70c*e* 15(21.4)c*e*
对照组 279 3068.06±602.23 9.20±0.95 9.86±0.77 9.89±0.73 29(10.4)
χ2值   29.46 79.83 67.41 127.81 132.7
P值   <0.05 <0.05 <0.05 <0.05 <0.05
分组 例数 Apgar评分≤7分[例(%)] 新生儿结局[例(%)]
1 min 5 min 正常 合并症 死亡
妊娠期高血压 61 3(4.9)ad* 2(3.3)ad* 49(86.0)ad 7(12.3) 1(1.8)
早发型子痫前期 68 21(30.9)b* 10(14.7)b* 56(83.6)b* 7(10.4) 4(6.0)
晚发型子痫前期 70 4(5.7)ce* 2(2.9)ce* 66(94.3)ce 2(2.9) 2(2.9)
对照组 279 6(2.2) 4(1.4) 254(94.4) 14(5.2) 1(0.4)
χ2值   48.66 18.91 16.09
P值   <0.05 <0.05 <0.05
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