| [Research Background and Objectives]Placental abruption（PA）is a serious complication of the third trimester of pregnancy,but also one of the serious complications of preeclampsia,with unpredictable,insidious onset,rapid onset,rapid progression of clinical features,if not early identification,intervention,will cause a huge threat to the mother and fetus.Studies have found that pregnant women with preeclampsia（PE）are 3 times more likely to have placental abruption than normal preeclampsia,according to relevant statistics[1],about 4.5%of pregnant women with severe preeclampsia have placental abruption at the same time.Patients with preeclampsia are themselves high-risk pregnancies,and when placental abruption is complicated,especially severe placental abruption,the rapid development of the disease is one of the important factors causing serious complications of perinatal mother and baby,and in severe cases,it can cause life threats to the mother and fetus.Therefore,early recognition and early intervention of preeclampsia complicated by placental abruption is still one of the problems that obstetricians need to focus on overcoming at present.This study focuses on the analysis of the clinical features of preeclampsia complicated by placental abruption,and provides a clinical evidence-based basis for the early identification and timely diagnosis and treatment of preeclampsia complicated by placental abruption through a comparative study of the general clinical features,related influencing factors and maternal and infant complications of the two groups of patients with preeclampsia.[Research Methods]This study used the retrospective controlled study method,strictly following the inclusion/exclusion criteria,and statistically analyzed 488 patients with preeclampsia singleton pregnancy who delivered in the hospital of Bethune First Hospital of Jilin University from January 1,2011 to December 31,2021,including 90 patients complicated by placental abruption and 398 patients without placental abruption.Among the 90 patients complicated by placental abruption,there were 53 cases of out-of-hospital placental abruption（emergency cesarean section on admission）,and 37cases of in-hospital placental abruption（confirmed during hospitalization）.Among them,there were 16 stillbirths in the group of preeclampsia complicated by placental abruption,74 newborns survived,66 cases were transferred to neonatology,5 cases were discharged with mothers,and 3 cases were abandoned by family members.In the group without placental abruption,there was 1 stillbirth,397 surviving newborns,228surviving neonates transferred to neonatology,and 169 discharged with mothers.1.Analyze and compare the clinical data of patients with preeclampsia complicated by placental abruption and preeclampsia without placental abruption from2011 to 2021,and include the clinical data of the two groups of patients,such as the age,the highest blood pressure before delivery,the history of childbirth,the history of miscarriage,etc,as well as the first relevant test indicators（hemoglobin,platelets,coagulation related indicators,liver and kidney function related indicators,etc.）of the two groups of patients admitted to the hospital,and use SPSS statistical software to test whether the above data follow the normal distribution.For quantitative data that follow the normal distribution,the t-test or t’test,the application of the Mann-Whitney U-rank sum test of the skewed distribution,and the chi-square test for related categorical variables were statistically analyzed,and the two sets of data of preeclampsia patients complicated by placental abruption and preeclampsia patients without placental abruption were compared respectively,and the relevant factors of preeclampsia complicated by placental abruption and the suspicious factors clinically considered to be complicated by placental abruption were screened out,and then multivariate logistic regression analysis was further used.To explore and identify the highly correlated factors of preeclampsia complicated by placental abruption.2.Analyze and compare maternal complications,fetal intrauterine conditions and neonatal complications in the two groups complicated by placental abruption and without placental abruption.3.Analyze and compare the differences in the timing of pregnancy termination and pregnancy termination methods between the two groups of patients with preeclampsia complicated by placental abruption.To compare whether there is a correlation between the confirmed gestational age of abruption and the gestational age of preeclampsia in people with placental abruption.4.Analyze the Page grading of all patients with preeclampsia complicated by placental abruption,and explore the impact of different degrees of placental abruption on the prognosis of mothers and children in patients with preeclampsia.[Research Results]1.Analysis of relevant factors of preeclampsia complicated by placental abruption:The results of univariate analysis showed that the highest systolic blood pressure（170mm Hg VS 165mm Hg,P=0.022）,blood uric acid value（479.52±139.62umol/L VS421.63±109.31umol/L,P=0.038）,hemoglobin（114.48±20.10g/L VS）before delivery in the two groups of patients with preeclampsia complicated by placental abruption and preeclampsia without placental abruption 120.66±17.38g/L,P=0.008),the difference was statistically significant.Platelets（P<0.001）,fibrinogen（P<0.001）,and D-dimer（P=0.001）were statistically significant.There were also statistical differences in renal function indexes[such as urea nitrogen（P<0.001）,serum creatinine（P<0.001）]and liver function indicators(such as aspartate aminotransferase（P=0.037）,lactate dehydrogenase（P<0.001）].Further multivariate logistic analysis showed that fibrinogen,D-dimer and lactate dehydrogenase were highly correlated factors complicated by preeclampsia and placental abruption,and the ORs（95%CI）were0.346（0.207-0.577）,1.001（1.001-1.002）,and 1.007（1.003-1.011）,respectively.2.ROC curve analysis showed that the AUCs of fibrinogen,D-dimer and lactate dehydrogenase were 0.648（0.561-0.734）,0.757（0.669-0.844）and 0.738（0.657-0.820）,respectively.When fibrinogen<3.96g/L,D-dimer>942.5ug/L and lactate dehydrogenase>313.5U/L,the Jordon index（0.301,0.499,0.392）was the largest for preeclampsia complicated by placental abruption,and the sensitivity of the three was0.648,0.556,0.556,and the specificity was 0.652,0.943 and 0.163,respectively,and the data analysis differences of the three were statistically significant（P<0.05）.3.The results showed that the placental abruption rate of fibrinogen reduction group（<3.96 g/L）,D-dimer elevated group（>942.5 ug/L）and lactate dehydrogenase increase group（>313.5 U/L）was higher than that of the control group in the same interval time,and the difference between the two groups was statistically significant（P<0.05）.Therefore,when abnormally low fibrinogen,abnormally elevated D-dimer,and abnormally elevated lactate dehydrogenase,patients with preeclampsia should be alerted to the possibility of placental abruption.4.Analysis of maternal pregnancy outcomes in the two groups of preeclampsia complicated by placental abruption and preeclampsia without placental abruption:the incidence of postpartum hemorrhage in pregnant women complicated by preeclampsia complicated by placental abruption was 10.0%,which was significantly higher than that in the preeclampsia group without placental abruption group with 2.3%;The incidence rates of DIC,uterine placental stroke and hemorrhagic shock in the group complicated by placental abruption were 4.4%,36.7%and 4.4%,respectively,while no such complications were seen in the group of patients without placental abruption.The differences in maternal complications between the above two groups were statistically significant（P<0.05）.5.Comparison of fetal intrauterine conditions and neonatal pregnancy outcomes in the preeclampsia complicated by placental abruption group:the incidence of fetal heart rate abnormalities（41.1%）,fetal distress（27.8%）and stillbirth（17.8%）in the preeclampsia complicated by placental abruption group was higher than that in the non-eclampsia group.In the group with placental abruption,the mean birth weight of neonates was 1665 g,and the average 1-minute Apgar score was 4 points,which was significantly lower than that in the group without placental abruption,and there were significant differences（P<0.05）.In addition,through follow-up of newborns transferred to the neonatal department,it was found that the incidence of neonatal asphyxia（50%）,neonatal respiratory distress syndrome（25.8%）and neonatal intracranial hemorrhage（21.2%）in the group complicated by placental abruption was higher than that in the group without placental abruption,and the average length of hospital stay of neonates in the group with placental abruption was 18 days,which was significantly longer than that of newborns in the non-abruption group with 10 days,and the above differences were statistically significant（P<0.05）.However,neonatal ischemic hypoxic encephalopathy in the preeclampsia and non-abruption groups was not statistically significant after analysis and comparison（P=0.729）.6.Influencing factors of neonatal prognosis:Further analysis of the Apgar score of newborns found that the 1-minute score of newborns was related to whether their mothers had abdominal pain and vaginal bleeding,and the average 1-minute Apgar score of newborns was 5.5 points when the mother had simple vaginal bleeding,the average 1-minute score of newborns was 1 point when there was simple persistent abdominal pain,and the average 1-minute Apgar score of newborns when there was both vaginal bleeding and persistent abdominal pain was 3.5 points.Among all 90patients with preeclampsia complicated by placental abruption,a total of 53 cases of placental abruption（emergency cesarean section on admission）occurred outside the hospital,and the remaining 37 cases were in-hospital abruption（placental abruption confirmed during hospitalization）,of which 13（81.3%）of the 16 stillbirths occurred in patients with out-of-hospital placental abruption,and only 3 stillbirths（18.7%）occurred in patients with nosocomial abruption.By analyzing the first symptoms and signs of in-hospital and extra-hospital abruption,it was found that the incidence of simple persistent abdominal pain（28.3%）and vaginal bleeding+persistent abdominal pain（28.3%）of out-of-hospital abruption was higher than that of in-hospital abruption,and the differences were statistically significant（P<0.05）.7.Analysis of gestational age and mode of delivery of preeclampsia complicated by placental abruption:In this study,the mean gestational age of delivery in the preeclampsia complicated by abruption group was significantly earlier（32.52±3.23weeks vs 36.28±2.44 weeks）compared with the gestational age of the non-abruption group（P<0.001）.Further analysis of the gestational age of the group complicated by placental abruption showed that there was a positive correlation between the gestational age of patients diagnosed with preeclampsia and the gestational age of confirmed placental abruption（r=0.952,p<0.001）.However,no significant difference was found between the two groups in the analysis of pregnancy termination mode（P=0.719）.8.Maternal and infant outcome analysis of preeclampsia complicated by different degrees of placental abruption:After analyzing the grade of abruption in all patients with placental abruption,46.7%of patients had a degree of abruption of grade II and III.When the degree of placental abruption in preeclampsia patients was grade II-III,the incidence of maternal uterine placental stroke（47.6%）,postpartum hemorrhage（11.9%）,DIC（7.1%）,and hemorrhagic shock（7.1%）were significantly higher than that of grade 0-I（27.1%,8.3%,2.1%,2.1%）,but there was only a statistically significant difference between the incidence of uterine placental stroke between the two groups（P=0.044）.There were no statistical differences in maternal complications between the remaining three groups（P=0.833,P=0.516,P=0.516）.Analysis comparing fetal intrauterine conditions and neonatal pregnancy outcomes found that the incidence of fetal heart abnormalities（61.9%）,fetal distress（52.4%）,and stillbirth（35.7%）in patients with grade II-III abruption was higher than that of grade 0-I（22.9%,6.3%,0.0%）,and the average Apgar scores of the former newborns at 1 minute and 5 minutes were lower than those of the latter（3 vs 6.5 points,8 vs 9 points）.The above differences were statistically significant（P<0.001,P<0.001,P<0.001,P<0.001,P=0.01）.The incidence of grade II-III neonatal asphyxia and ischemic hypoxic encephalopathy（68%and 20%）was higher than that of grade 0-I（41%and 0.0%）,and the difference was statistically significant（P=0.035,P=0.007）.[Research Conclusion]1.Fibrinogen,D-dimer,and lactate dehydrogenase are all important factors associated with preeclampsia complicated by placental abruption.When FIB values decrease,D-D values increase,and LDH values increase,high vigilance should be placed on the occurrence of preeclampsia complicated by placental abruption.And the detection of outliers earlier before delivery,combined with the timely termination of pregnancy in combination with the situation of the mother and baby,may reduce the risk of placental abruption in patients with preeclampsia.2.Preeclampsia complicated by placental abruption increases the risk of maternal liver and kidney function damage to a certain extent,and increases the incidence of various adverse pregnancy outcomes in mothers and infants.3.Out-of-hospital placental abruption and maternal symptoms and signs（persistent abdominal pain,vaginal bleeding）are important factors affecting the prognosis of newborns,and delays in presentation and diagnosis increase the incidence of poor prognosis of newborns to some extent.And the length of neonatal hospitalization will increase significantly,which will increase the social and family burden to a certain extent.4.Preeclampsia complicated by placental abruption carries a greater risk of preterm birth.The earlier the gestational age of preeclampsia,the earlier the placental abruption,and there is a positive correlation between the two.5.The main factor affecting maternal and infant prognosis is the Page grade,and the more severe the placental abruption in a patient with preeclampsia,the greater the risk of adverse maternal and infant pregnancy outcomes. |
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