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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) : 89 -95. doi: 10.3877/cma.j.issn.2095-3259.2021.02.006

论著

子痫前期并发胎儿生长受限的临床特征及妊娠结局分析
陈娟娟1, 孙雯1, 苏春宏1, 林琳1, 周燕媚1, 余琳1, 杜丽丽1, 陈兢思1, 陈敦金1,†()   
  1. 1. 510150　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
  • 收稿日期:2021-02-08 出版日期:2021-05-18
  • 通信作者: 陈敦金
  • 基金资助:
    国家自然科学基金重点项目(81830045)

Clinical characteristics and pregnancy outcomes of preeclampsia complicated with fetal growth restriction

Juanjuan Chen1, Wen Sun1, Chunhong Su1, Lin Lin1, Yanmei Zhou1, Lin Yu1, Lili Du1, Jingsi Chen1, 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
  • Received:2021-02-08 Published:2021-05-18
  • Corresponding author: Dunjin Chen
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引用本文：

陈娟娟, 孙雯, 苏春宏, 林琳, 周燕媚, 余琳, 杜丽丽, 陈兢思, 陈敦金. 子痫前期并发胎儿生长受限的临床特征及妊娠结局分析[J]. 中华产科急救电子杂志, 2021, 10(02): 89-95.

Juanjuan Chen, Wen Sun, Chunhong Su, Lin Lin, Yanmei Zhou, Lin Yu, Lili Du, Jingsi Chen, Dunjin Chen. Clinical characteristics and pregnancy outcomes of preeclampsia complicated with fetal growth restriction[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2021, 10(02): 89-95.

目的

探讨子痫前期并发胎儿生长受限(fetal growth restriction，FGR)的临床特征及母儿结局。

方法

回顾性分析2009年1月1日至2019年12月31日在广州医科大学附属第三医院产科就诊并分娩的单胎子痫前期患者的病例资料，根据是否合并FGR，分为FGR组和对照组，分析两组的临床特征及母儿结局。

结果

(1)2960例单胎子痫前期患者合并FGR的发生率为20.68%，早发型及晚发型子痫前期合并FGR的发生率分别为30.3%及13.7%(P<0.05)；(2)两组受教育程度、妊娠次数、受孕方式及入院类型比较差异均有统计学意义(P均<0.05)；(3)FGR组活产分娩孕周[(33.44±3.13)周]明显小于对照组[(35.82±3.78)周]，FGR组死胎率(15.03%)、剖宫产率(80.39%)及住院天数[(9.21±4.70)d]，均明显高于对照组[10.78%、71.12%、(8.45±6.34)d]，FGR组胎儿窘迫(24.18%)、羊水过少(13.89%)的发生率明显高于对照组(10.09%、6.39%)，差异均具有统计学意义(P<0.05)；(4)FGR组≥28周不同孕周阶段的新生儿平均体重、平均身长及平均头围均低于对照组，FGR组新生儿窒息(21.0%)、新生儿呼吸窘迫(18.65%)、肺透明膜病(4.62%)、新生儿贫血(17.69%)的发生率都明显高于对照组(14.1%、10.60%、2.82%、7.97%)，差异均具有统计学意义(P<0.05)。

结论

子痫前期与FGR的发生密切相关，子痫前期患者合并FGR时出现不良母儿结局的风险增加。

关键词: 子痫前期, 胎儿生长受限, 妊娠结局
Objective

To investigate the clinical features and maternal and neonatal outcomes of preeclampsia complicated with fetal growth restriction (FGR).

Methods

The clinical data of patients with preeclampsia, who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2009 to December 31, 2019, were retrospectively analyzed. According to whether they were complicated with FGR, they were divided into FGR group and control group. The clinical characteristics and maternal and neonatal outcomes of two groups were analyzed.

Results

(1) The incidence of FGR in 2960 cases of preeclampsia was 20.68%. The incidences of FGR in early-onset and late-onset preeclampsia were 30.3% and 13.7%, respectively (P<0.05). (2) There were significant differences in educational level, gravidity, mode of conception and type of admission between the two groups (all P<0.05). (3) In FGR group, the gestational age of live birth (33.44±3.13) was significantly less than that in control group (35.82±3.78), the stillbirth rate (15.03%), cesarean section rate (80.39%) and hospital stay [(9.21±4.70)d] were significantly higher than those in control group [10.78%, 71.12%, 8.45±6.34 (d)], the incidences of fetal distress (24.18%) and oligohydramnios (13.89%) in FGR group were significantly higher than those in control group (10.09% and 6.39%) (P<0.05). (4) The results showed that the average weight, length and head circumference of newborns in FGR group were lower than those in control group. The incidence of neonatal asphyxia (21.0%), neonatal respiratory distress (18.65%), pulmonary hyaline membrane disease (4.62%) and neonatal anemia (17.69%) in FGR group were significantly higher than those in control group (14.1%, 10.60%, 2.82% and 7.97%), the differences were statistically significant (P<0.05).

Conclusions

Preeclampsia is closely related to the occurrence of FGR. Preeclampsia patients complicated with FGR have an increased risk of adverse maternal and neonatal outcomes.

Key words: Pre-eclampsia, Fetal growth restriction, Pregnancy outcome
表1 两组患者一般特征比较[例(%)]
组别 例数 受教育程度 妊娠次数 辅助生殖受孕
≤12年 >12年 1次 2次 3次 ≥4次
FGR组 612 453(74.02) 159(25.98) 158(25.82) 184(30.07) 141(23.04) 129(21.08) 41(6.70)
对照组 2348 1520(64.7) 828(35.26) 760(32.37) 651(27.73) 476(20.27) 461(19.63) 244(10.39)
χ2值   18.825 9.951 7.607
P值   0.000 0.019 0.006
组别 例数 产次 入院类型
0次 1次 2次 ≥3次 门诊 急诊 转诊
FGR组 612 306(50.00) 248(40.52) 51(8.33) 7(1.14) 221(36.11) 126(20.59) 265(43.30)
对照组 2348 1272(54.17) 870(37.05) 164(6.98) 42(1.79) 1009(42.97) 636(27.09) 703(29.94)
χ2值   5.570 39.962
P值   0.135 0.000
表2 两组患者妊娠结局比较
组别 例数 死胎[例(%)] 分娩孕周(周，±s) 分娩方式[例(%)] 转诊ICU[例(%)] 住院天数(d，±s) 死亡[例，(%)]
活产 死胎 阴道分娩 剖宫产
FGR组 612 92(15.03) 33.44±3.13 28.04±2.66 120(19.61) 492(80.39) 51(8.33) 9.21±4.70 0(0.00)
对照组 2348 253(10.78) 35.82±3.78 27.61±4.41 678(28.88) 1670(71.12) 195(8.30) 8.45±6.34 3(0.13)
χ2/t值   21.176 13.223 0.886 21.176 0.001 3.256 0.783
P值   0.003 0.000 0.376 0.000 0.982 0.001 0.376
表3 两组患者分娩孕周构成比[例(%)]
组别 例数 <28周 28～33+6周 34～36+6周 ≥37周
FGR组          
  活产 520 12(2.31) 277(53.27) 135(25.96) 96(18.46)
  死胎 92 49(53.26) 40(43.48) 3(3.26) 0(0.00)
对照组          
  活产 2095 50(2.39) 591(28.21) 405(19.33) 1049(50.07)
  死胎 253 146(57.71) 81(32.02) 18(7.11) 8(3.16)
表4 两组患者妊娠合并症及并发症比较[例(%)]
组别 例数 HELLP综合征 子痫 胎儿窘迫 胎盘早剥 胎膜早破
FGR组 612 63(10.29) 3(0.49) 148(24.18) 8(1.31) 17(2.78)
对照组 2348 207(8.82) 22(0.94) 237(10.09) 19(0.81) 187(7.96)
χ2值   1.279 1.157 85.169 1.332 20.350
P值   0.258 0.282 0.000 0.248 0.000
组别 例数 羊水过少 产后出血 糖尿病 贫血 心功能不全
FGR组 612 85(13.89) 13(2.12) 95(15.52) 156(25.49) 46(7.52)
对照组 2348 150(6.39) 174(7.41) 548(23.34) 891(37.95) 168(7.16)
χ2值   37.367 22.923 17.442 32.954 0.094
P值   0.000 0.000 0.000 0.000 0.759
组别 例数 肾功能不全 血小板减少 系统性红斑狼疮 甲状腺疾病 抗磷脂综合征
FGR组 612 14(2.29) 15(2.45) 23(3.76) 59(9.64) 1(0.16)
对照组 2348 33(1.41) 57(2.43) 72(3.07) 254(10.82) 3(0.13)
χ2值   2.418 0.001 0.748 0.711 0.046
P值   0.120 0.973 0.387 0.399 0.831
表5 两组患者新生儿一般情况比较(±s)
组别 例数 新生儿出生体重(g)
<28周 28～33+6周 34～36+6周 ≥37周
FGR组 520 701.67±142.39 1133.08±235.07 1679.85±287.88 2187.46±337.88
对照组 2095 908.88±823.08 1414.22±392.69 2314.17±486.86 3146.92±457.88
t值   1.679 11.024 14.321 20.034
P值   0.099 0.000 0.000 0.000
组别 例数 新生儿身长(cm)
<28周 28～33+6周 34～36+6周 ≥37周
FGR组 520 32.50±4.15 37.52±2.74 42.08±2.39 45.30±2.26
对照组 2095 33.36±2.62 39.78±2.38 45.68±2.67 49.46±2.05
t值   0.905 9.689 13.843 17.411
P值   0.369 0.000 0.000 0.000
组别 例数 新生儿头围(cm)
<28周 28～33+6周 34～36+6周 ≥37周
FGR组 520 23.36±1.29 26.78±1.87 29.38±1.73 31.02±1.69
对照组 2095 23.82±2.77 28.11±2.00 31.53±1.71 33.16±1.50
t值   0.817 9.463 12.551 12.010
P值   0.420 0.000 0.000 0.000
表6 两组患者新生儿并发症比较[例(%)]
组别 例数 先天性心脏病 新生儿呼吸窘迫 肺炎 肺透明膜病 肺出血 坏死性肠炎
FGR组 520 2(0.38) 97(18.65) 27(5.19) 24(4.62) 9(1.73) 13(2.50)
对照组 2095 14(0.67) 222(10.60) 81(3.87) 59(2.82) 31(1.48) 28(1.34)
χ2值   0.551 25.250 1.850 4.388 0.174 3.654
P值   0.458 0.000 0.174 0.036 0.676 0.056
组别 例数 胃肠道出血 颅内出血 败血症 新生儿贫血 多器官功能损害
FGR组 520 4(0.77) 19(3.65) 9(1.73) 92(17.69) 10(1.92)
对照组 2095 11(0.53) 234(11.17) 21(1.00) 167(7.97) 28(1.34)
χ2值   0.435 26.927 1.949 44.117 1.001
P值   0.509 0.000 0.163 0.000 0.317
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