Correlative Factor Analysis Of Adverse Pregnancy Outcome Of Hypertensive Disorders Complicating Pregnancy

The patheogeny of hypertensive disorder complicating pregnancy is unclear until now, and the pathogenesis is complex, while the clinical harm is serious, and it often gives rise to adverse pregnancy outcome. Through the retorspective analysis of pregnancy outcome of 354 HDCP in our hospital during 3 yearst, the article studies the relation of varous factors and pregnancy outcome of HDCP, confirms correlation factor of adverse pregnancy outcome of HDCP.Objetive:Study the relation of varous factors and pregnancy outcome of HDCP, confirm correlation factor of adverse pregnancy outcome of HDCP.Methods:Retrospectively analuze cases of inpatient childbirth between January 2007 and Dcecember 2010 at the Second Hospital ofJilin University, among which 354 cases were diagnosed as HDCP and complete. Through statistics analysis comparison, Study the relationship between varous factors and pregnancy outcome of HDCP, and confirm correlation factor of adverse pregnancy outcome of HDCP by multivariat logistic regression analysis.Results:1.Morbidity situation of adverse pregnancy outcome of HDCP:(1)Adverse pregnancy outcome of mother: among 354 HDCP cases, 164 cases had complications, the morbidity was 46.3%: 18 cases of placental abruption, 3 cases of acute heart failure, 15 cases of HELLP syndrome, 15 cases of acute renal insufficiency, 74 cases of retinopathy, 51 cases of ascites, 42 cases of oligohydramnios, 7 cases of postpartum hemorrhage. 1 case complicated by four kinds of complications, 10 case complicated by three kinds of complications, 39 cases complicated by two kinds of complications. 2 cases of maternal death had complications, one of which had heart failure and HELLP syndrome, the other had heart failure, DIC and ARDS. (2)Adverse pregnancy outcome of fetus: among 372 fetus, 194 cases had adverse pregnancy outcome, the morbidity was 52.2%: 57 cases of death, 49 cases of fetal distress , 127 cases of FGR. 1 case complicated by three kinds of adverse pregnancy outcome, 45 cases complicated by two kinds of adverse pregnancy outcome.(3)Adverse pregnancy outcome of neonate: among 315 neonates,145 cases had adverse pregnancy outcome, the morbidity was 46.0%: 8 cases of death, 113 cases of SGA, 71 cases of asphyxia of newbron. 4 case complicated by three kinds of adverse pregnancy outcome, 37 cases complicated by two kinds of adverse pregnancy outcome.(4)Adverse pregnancy outcome of mother and fetus/neonate: among 354 cases, 118 cases had mother and fetus/neonate adverse pregnancy outcome, the morbidity was 33.3%.2.Relationship between severity of HDCP and pregnancy outcome:(1)Adverse pregnancy outcome of mother: gestational hypertension, mild pre-eclampsia, severe pre-eclampsia and eclampsia, with the aggravation of severity degree, the morbidity of the adverse pregnancy outcome of mother obviously elevate (P<0.05). The morbidity of pre-eclampsia superimposed upon chronic hypertension is higher than mild pre-eclampsia, and lower than severe pre-eclampsia. The morbidity of chronic hypertension in pregnancy is similar to gestational hypertension.(2)Adverse pregnancy outcome of fetus: gestational hypertension, mild pre-eclampsia, severe pre-eclampsia and eclampsia, with the aggravation of severity degree, the morbidity of death, FGR and the adverse pregnancy outcome of fetus obviously elevate (P<0.05). The morbidity of pre-eclampsia superimposed upon chronic hypertension is higher than severe pre-eclampsia, and lower than eclampsia. The morbidity of chronic hypertension in pregnancy is higher than gestational hypertension.(.3)Adverse pregnancy outcome of neonate: mild pre-eclampsia, severe pre-eclampsia and eclampsia, with the aggravation of severity degree, the morbidity of asphyxia of newbron, SGA and the adverse pregnancy outcome of neonate obviously elevate (P<0.05). The morbidity of pre-eclampsia superimposed upon chronic hypertension is higher than severe pre-eclampsia, and lower than eclampsia. The morbidity of chronic hypertension in pregnancy is lower than gestational hypertension.(4)Adverse pregnancy outcome of mother and fetus/neonate: mild pre-eclampsia, severe pre-eclampsia and eclampsia, with the aggravation of severity degree, the morbidity of adverse pregnancy outcome of mother-fetus/neonate obviously elevate (P<0.05). The morbidity of pre-eclampsia superimposed upon chronic hypertension is higher than severe pre-eclampsia, and lower than eclampsia.3.Relationship between proteinuria of HDCP and pregnancy outcome:According severity of proteinuria, the patients were divided into three groups (-)⁺,(++),(+++)⁺⁺⁺⁺, has 65 cases, 77 cases and 212 cases separately. Proteinuria is diagnosis standard of HDCP, which is related with the severity of HDCP (P<0.05). With the aggravation of proteinuria, the morbidity of retinopathy, ascites and adverse pregnancy outcome of mother obviously elevate (P<0.05); the morbidity of death, FGR and adverse pregnancy outcome of fetus obviously elevate (P<0.05); the morbidity of SGA and adverse pregnancy outcome of neonate obviously elevate (P<0.05); the morbidity of adverse pregnancy outcome of mother-fetus/neonate obviously elevate (P<0.05).4.Relationship between gestational weeks of HDCP and pregnancy outcome:4.1 Relationship between nosopoietic gestational weeks and pregnancy outcome: With the aggravation of severity of HDCP, the nosopoietic gestational weeks of gestational hypertension, mild pre-eclampsia, severe pre-eclampsia and eclampsia become earlier (P<0.05). The nosopoietic gestational weeks of pre-eclampsia superimposed upon chronic hypertension is later than severe pre-eclampsia, and earlier than eclampsia. With the advance of nosopoietic gestational weeks, the morbidity of retinopathy, HELLP syndrome, acute renal insufficiency and adverse pregnancy outcome of mother obviously elevate (P<0.05); the morbidity of death, FGR and adverse pregnancy outcome of fetus obviously elevate (P<0.05); the morbidity of death, SGA, asphyxia of newbron and adverse pregnancy outcome of neonate obviously elevate (P<0.05); the morbidity of adverse pregnancy outcome of mother-fetus/neonate obviously elevate (P<0.05).4.2 Relationship between delivery gestational weeks and pregnancy outcome: With the aggravation of severity of HDCP, the delivery gestational weeks of gestational hypertension, mild pre-eclampsia, severe pre-eclampsia and eclampsia become earlier (P<0.05). The delivery gestational weeks of pre-eclampsia superimposed upon chronic hypertension is later than severe pre-eclampsia, and earlier than eclampsia. The delivery gestational weeks are related with dverse pregnancy outcome of mother (P<0.05). When dverse pregnancy outcome happens, it always terminates prgnancy in advance for reducing harm. With the advance of delivery gestational weeks, the morbidity of death, FGR and adverse pregnancy outcome of fetus obviously elevate (P<0.05); the morbidity of death, SGA, asphyxia of newbron and adverse pregnancy outcome of neonate obviously elevate (P<0.05); the morbidity of adverse pregnancy outcome of mother-fetus/neonate obviously elevate (P<0.05).5.The influnce of age to pregnancy outcome of HDCPElderly pregancy compared with non-elderly pregancy, the morbidity of death of neonate obviously elevate (P<0.05), but the morbidity of adverse pregnancy outcome of mother don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of fetus don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of neonate don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of mother-fetus/neonate don't have significant difference (P>0.05).6.The influnce of multiple pregnancy to pregnancy outcome of HDCPMultiple pregancy compared with single pregancy, the morbidity of adverse pregnancy outcome of neonate obviously elevate (P<0.05), but the morbidity of adverse pregnancy outcome of mother don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of fetus don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of mother-fetus/neonate don't have significant difference (P>0.05).7.The influnce of parity to pregnancy outcome of HDCPPrimipara compared with multipara, the morbidity of adverse pregnancy outcome of mother don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of fetus don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of neonate don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of mother-fetus/neonate don't have significant difference (P>0.05).8.The influnce of delivery method to pregnancy outcome of HDCPVaginal delivery compared with cesarean section, the morbidity of death and adverse pregnancy outcome of fetus obviously elevate (P<0.05); the morbidity of death of neonate obviously elevate (P<0.05), but the morbidity of adverse pregnancy outcome of neonate don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of mother don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of mother-fetus/neonate don't have significant difference (P>0.05).9. The influnce of comorbidities to pregnancy outcome of HDCPComorbidities compared with non-comorbidities, the morbidity of adverse pregnancy outcome of mother don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of fetus don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of neonate don't have significant difference (P>0.05); the morbidity of adverse pregnancy outcome of mother-fetus/neonate don't have significant difference (P>0.05).10. Correlation factor of adverse pregnancy outcome of HDCP(1) Single factor analysis: the correlation factors of adverse pregnancy outcome of mother are severity of HDCP, proteinuria, nosopoietic/delivery gestational weeks; the correlation factors of adverse pregnancy outcome of fetus are severity of HDCP, proteinuria, nosopoietic/delivery gestational weeks and delivery method; the correlation factors of adverse pregnancy outcome of neonate are severity of HDCP, proteinuria, nosopoietic/delivery gestational weeks and multiple pregnancy; the correlation factors of adverse pregnancy outcome of mother-fetus/neonate are severity of HDCP, proteinuria, nosopoietic/delivery gestational weeks.(2) Multivariat logistic regression analysis: multivariat logistic regression analysis the factors which have significance by single factor analyse, the correlation factors of adverse pregnancy outcome of mother are proteinuria, nosopoietic gestational weeks; the correlation factors of adverse pregnancy outcome of fetus are proteinuria, delivery gestational weeks; the correlation factors of adverse pregnancy outcome of neonate are proteinuria, delivery gestational weeks; the correlation factors of adverse pregnancy outcome of mother- fetus/neonate are proteinuria, delivery gestational weeks.Conclusion:1. Severity of HDCP is risk factor of adverse pregnancy outcome. With the aggravation of severity degree, the morbidity of the adverse pregnancy outcome of mother, fetus, neonate and mother- fetus/neonate obviously elevate (P<0.05).2. Proteinuria is risk factor of adverse pregnancy outcome. With the aggravation of proteinuria, the morbidity of the adverse pregnancy outcome of mother, fetus, neonate and mother- fetus/neonate obviously elevate (P<0.05).3. Nosopoietic/delivery gestational weeks is protctive factor of adverse pregnancy outcome. With the advance of nosopoietic/delivery gestational weeks, the morbidity of the adverse pregnancy outcome of mother, fetus, neonate and mother- fetus/neonate obviously elevate (P<0.05).4. Elderly and multiple pregnancy may be protctive factors.5. Cesarean section is the safe and fast method to terminate duration of HDCP, and reduces adverse pregancy outcome.6. By multivariat logistic regression analysis, the correlation factors of adverse pregnancy outcome of mother are proteinuria, nosopoietic gestational weeks; the correlation factors of adverse pregnancy outcome of fetus neonate and mother- fetus/neonate are proteinuria, delivery gestational weeks.