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

doi:10.3877/cma.j.issn.2095-3259.2021.02.005

Chinese Journal of Obstetric Emergency(Electronic Edition) ›› 2021, Vol. 10 ›› Issue (02): 82-88. doi: 10.3877/cma.j.issn.2095-3259.2021.02.005

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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. 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 Online:2021-05-18 Published:2021-07-14
Contact: 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

Abstract

Abstract:

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

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.

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Figures/Tables 4

References 17

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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)
分组	例数	年龄(岁，±s)	汉族	其他	孕前体重(kg，±s)	住院体重(kg，±s)	孕期增重(kg，±s)
妊娠期高血压	61	33.30±4.69^ad	56(91.8)^ad	5(8.2)	62.13±10.00^ad	74.46±10.84^ad	12.33±3.14^a*d
早发型子痫前期	68	32.13±5.19^b	66(97.1)^b	2(2.9)	62.60±7.37^b*	74.32±8.74^b	11.72±3.66^b*
晚发型子痫前期	70	32.64±4.30^ce	68(97.1)^ce	2(2.9)	63.20±10.60^c*e	76.82±11.35^c*e	13.62±3.67^ce*
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±3.61^ad	3.25±1.18^ad	1.15±0.40^ad	40(65.6)^ad	1.10±1.11^ad	1.13±0.39^ad
早发型子痫前期	68	28.40±3.16^b	3.43±1.24^b*	1.24±0.52^b	46(67.6)^b	1.19±1.16^b	1.21±0.48^b*
晚发型子痫前期	70	29.68±3.82^ce	3.21±1.17^ce	1.23±0.49^c*e	43(61.4)^ce	0.99±0.99^ce	1.20±0.50^ce
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(%)]
分组	例数	距上次剖宫产(月，±s)	辅助生殖受孕[例(%)]	转诊[例(%)]	男	女	糖尿病[例(%)]
妊娠期高血压	61	63.30±33.44^ad	2(3.3)^ad	24(39.3)^ad	33(57.9)^ad	24(42.1)	17(31.5)^ad
早发型子痫前期	68	68.84±42.83^b	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±35.76^ce	2(2.9)^ce	21(16.3)^ce	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)
分组	例数	高血压病史[例(%)]	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	孕周(周，±s)
妊娠期高血压	61	9(14.8)^a*d	40(65.6)^ad	18(29.5)	3(4.9)	36.15±2.72^ad
早发型子痫前期	68	12(17.6)^b*	42(61.8)^b	25(36.8)	1(1.5)	31.16±2.10^b*
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±1.35^ce*
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

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)
分组	例数	年龄(岁，±s)	汉族	其他	孕前体重(kg，±s)	住院体重(kg，±s)	孕期增重(kg，±s)
妊娠期高血压	61	33.30±4.69^ad	56(91.8)^ad	5(8.2)	62.13±10.00^ad	74.46±10.84^ad	12.33±3.14^a*d
早发型子痫前期	68	32.13±5.19^b	66(97.1)^b	2(2.9)	62.60±7.37^b*	74.32±8.74^b	11.72±3.66^b*
晚发型子痫前期	70	32.64±4.30^ce	68(97.1)^ce	2(2.9)	63.20±10.60^c*e	76.82±11.35^c*e	13.62±3.67^ce*
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±3.61^ad	3.25±1.18^ad	1.15±0.40^ad	40(65.6)^ad	1.10±1.11^ad	1.13±0.39^ad
早发型子痫前期	68	28.40±3.16^b	3.43±1.24^b*	1.24±0.52^b	46(67.6)^b	1.19±1.16^b	1.21±0.48^b*
晚发型子痫前期	70	29.68±3.82^ce	3.21±1.17^ce	1.23±0.49^c*e	43(61.4)^ce	0.99±0.99^ce	1.20±0.50^ce
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(%)]
分组	例数	距上次剖宫产(月，±s)	辅助生殖受孕[例(%)]	转诊[例(%)]	男	女	糖尿病[例(%)]
妊娠期高血压	61	63.30±33.44^ad	2(3.3)^ad	24(39.3)^ad	33(57.9)^ad	24(42.1)	17(31.5)^ad
早发型子痫前期	68	68.84±42.83^b	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±35.76^ce	2(2.9)^ce	21(16.3)^ce	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)
分组	例数	高血压病史[例(%)]	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	孕周(周，±s)
妊娠期高血压	61	9(14.8)^a*d	40(65.6)^ad	18(29.5)	3(4.9)	36.15±2.72^ad
早发型子痫前期	68	12(17.6)^b*	42(61.8)^b	25(36.8)	1(1.5)	31.16±2.10^b*
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±1.35^ce*
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

分组	转诊		高血压病史
分组	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

分组	转诊		高血压病史
分组	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

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±3.45^ad
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±4.37^b*
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±3.00^ce*
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

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分组	例数	新生儿出生体重(g，±s)	Apgar评分(分，±s)			NICU[例(%)]
分组	例数	新生儿出生体重(g，±s)	1 min	5 min	10 min	NICU[例(%)]
妊娠期高血压	61	2848.40±655.92^ad	9.05±1.73^ad*	9.66±1.38^ad*	9.74±1.32^ad*	19(31.1)^ad
早发型子痫前期	68	1482.46±596.57^b*	7.66±2.66^b*	8.68±2.36^b*	8.76±2.56^b*	52(76.5)^b*
晚发型子痫前期	70	3006.29±556.39^ce*	8.87±1.77^ce*	9.49±1.70^ce	9.53±1.70^ce	15(21.4)^ce
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(%)]
分组	例数	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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Clinical characteristics of pregnant women complicated with early onset preeclampsia with prior cesarean section due to hypertensive disorders of pregnancy

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