Study The Morbidity Regularity Of Pregnancy-induced Hypertension Syndrome Severe Complications In Clinic

Pregnancy-induced hypertension syndrome(PIH) is the special disease in gestational period. The characteristic of the syndrome is multisystem and organ impared representing hypertension, proteinuria, edema mainly. The morbidity is 6%~8% in developed country, and 9.4% in China mainland.It took almost a century to research the syndrome, considerable investigation had done in etiopathogenisis, pathogenesy, prognosis, prevention, early diagnosis and therapy, and it had acquired importance progression, but the etiopathogenisis and pathogenesis of PIH are still uncertainty. Therefore, effective prevention and cure is insufficient in clinic, the main of treatment is symptomatic treatment and termination of pregnancy. There are unsatisfied therapeutic efficacy and high risk of gravidity , puerperant and perinatal newborn morbidity exist in part of PIH patients, especial in the severe patients, which have already lead to various kinds of complications.By the development of molecular biology, and by the development of the research of etiopathogenisis, pathogenesy, prognosis, prevention, early diagnosis and therapy of PIH, obstetrician have been understanding the syndrome gradually. The main complications that cause gravidity and puerperant death is HELLP syndrome and DICin developed country, angiocardiopathy and cerebral vascular accident are seldom seen. The main cause of PIH patients death is cerebral vascular accident, acute heart failure, renal failure and DIC from 1981 to 1990 in Shanghai.The report of the national seminar of the diagnosis and therapy of PIH and complications in 1993 indicated: the complications that could lead to patients death was cerebral vascular accident, heart failure, acute renal failure, HELLP syndrome, pneumonedema and PIH complicating hydroperitoneum. In recent years, the health protection of gravidity , puerperant and perinatal newborn have been regarded by our government, obstetricians have done much work about the anticipation, preservation, morning diagnose and therapy of PIH many years. The way of remedy has been improving noticeable by the cooperation of anesthesiology, neonatology, medicine and surgery. During the 10 years of development, what's differences about the condition of severe complications of PIH and the main cause of PIH patients death by comparing the one in 10 years ago? In nowdays, most of the reports of these questions are small sample research in single hospital, or the analysis of single complication in our country. Because lack of large sample and systematic and full-scale investigation, we can't analyse the change regularity of PIH severe complications and the constituent ratio of complications which cause the death of gravidity , puerperant and perinatal newborn morbidity on the whole.By studying the large sample clinical data which comes from 4107 cases of PIH in 4 hospitals in Guangzhou from 1995 to 2004 retrospectively, to analyse the incident condition of the severe complications and the influence on the results of pregnancy, to approach the related high risk of the severe complications, all of these are done for learning the severe complications better in clinic.Materials and MethodsRetrospective study the 71020 cases who deliveried in hospital from 1995 to 2004, all of the clinical data comes from Nanfang hospital, Zhujiang hospital, Guangzhou second people's hospital and Hexian memorial hospital. The diagnosis standard of PIH is in accordance with the fifth publication of Obstetrics and Gynecology which Lejie to edit in chief. Among the 71020 cases, there are 1141 cases with severe PIH, 1138 cases with midrange PIH, 1828 cases with mitis PIH.There are 199 patients among the 4107 cases with severe complications of PIH: 69 cases with placental abruption, 43 cases with hypertension induced cardiopathy (36 cases with acute heart failure), 38 cases with DIC, 40 cases with renal failure, 24 cases with cerebrovascular accident, 21 cases with HELLP syndrome. There 36 cases with multi-severe complications among the total.There are 4164 cases of perinatal newborns in which twin pregnancy are 206 cases, triplet pregnancy are 3 cases; there are 4102 newborns, 217 newborns died in peripartum in which twins death are 13 cases, twin death in are 3 cases.To analyse PIH morbidity and it's severe complications morbidity.To analyse the influence of the prognosis of gravida and parturient and perinatal newborn.To compare the differences about premature delivery, fetal growth restriction, fetal distress, neonatal asphyxia, low birth weight infant, perinatal newborn death, gestational age of newborn, birth weight and the prognosis of prognosis of gravida and puerperant between the severe complications group and the non-severe complications group.The research content include the PIH patients group's social background data, obstetrical factor and pregnancy complications, etc. To analyse this data by using Logistic gradual regressive analysis, to retrieval the related high risk factor of severecomplications of PIH.Statistical methodData is arranged and each index are quantificated. And all the statistical job are undertook by using SPSS 10.0 software, the statistical analysis include t-test, x2-test, and mult-factor Logistic gradual regressive analysis, P<0.05 indicate statistically significance.Result1. The morbidity of PIH is 5.78% in which the morbidity of severe PIH is 27.78% (1141/4107) , the morbidity of midrange PIH is 27.71% (1138/4107) , the morbidity of mitis PIH is 44.51%. Maternal mortality rate is 0.19% (8/4107) , the specific mortality rate is 11.26/100000. Perinatal mortality rate is 3.01% (130/4314) .2 Most of severe complications of PIH occurred in severe PIH. Each proporion of severe complications in PIH from large to small are as follow: placental abruption is 1.68%, DIC is 1.24%, PIH induced cardiopathy is 1.05%, renal failure is 0.97%, cerebrovascular accident is 0.51%, HELLP syndrome is 0.51%.Each proporion of severe complications in severe PIH from large to small are as follow: placental abruption is 5.57%, DIC is 4.38%, PIH induced cardiopathy is 3.75%, renal failure is 2.83%, cerebrovascular accident is 2.10%, HELLP syndrome is 1.84%.Each morbidity of PIH severe complications caused are as follow: cerebro vascular accident is 16.7% (4/24) , DIC is 9.8% (2/41) , HELLP syndrome is 9.5% (2/21) , PIH induced cardiopathy is 2.3% (1/43) , acute renal failure and placental abruption didn't happen.Each perinatal mortality rate with PIH severe complications are as follow:placental abruption is 47.8% (33/69) , HELLP syndrome is 45.5% (10/22) ,DICis 40% (18/45 ), renal failure is 26.2% (11/42), cerebrovascular accident is 24% (6/25 ), PIH induced cardiopathy is 17.4% (8/46) .4. In the PIH severe complications group, the gestational age of newborn is 34.57+5.15 weeks, birth weight is 1828+765 gram; in the non-severe complications group, the gestational age of newborn is 36.97+3.86 weeks, birth weight is 3046+ 680 gram. Both gestational age and birth weight have differences are statistically significance between the 2 groups.5. Each propotion of perinatal newborn in severe complications are as follow: premature infant is 83.8% (176/210) , FGR is 76.2% (160/210) , perinatal newborn death is 30.9% (65/210) , fetal distress 59.6% (125/210) , asphyxia neonatorum is 63.5% ( 133/210) , all of these propotions are larger than the propotions of non-complications group.6. The result of Logistic gradual regressive analysis: educational level is lower than junior high school, without systemic antenatal examination, fluid population; twin or multiple pregnancy, pregnancy complicating severe medical disease (chonic hypertension, hyperthyreosis, anemia, carbohydrate tolerance dysfunction, hepatitis) and age below 20 years old add the dange of severe complications of PIH .Conclusion1. The morbidity of PIH is 5.78%, it is conspicuous lower than the total morbidity in entire country which is 9.4%.2. The morbidity of PIH severe complications from high to low in order are: placental abruption, DIC, PIH induced cardiopathy, renal failure, cerebro vascular accident. HELLP syndrome.3. The main causes that lead gravidity and puerperant to death are: cerebrovascular accident, DIC, HELLP syndrome, acute heart failure.4. The complications do harm to perinatal newborn seriously range from heaviest to heavier in order are: placental abruption, DIC, HELLP syndrome, PIH induced cardiopathy and cerebro vascular accident.5. The complications are the main causes of perinatal newborn death because newborns with severe complications of PIH are small gestational age and low birth weight.6. The main high risk factors of severe complications of PIH: educational level is lower than junior high school, without systemic antenatal examination, fluid population; twin or multiple pregnancy, pregnancy complicating severe medical disease ( chonic hypertension, hyperthyreosis, anemia, carbohydrate tolerance dysfunction, hepatitis) and age below 20 years old.