| Background:Hypertensive disorder complicating pregnancy(HDCP)is a common and spe cific disease which belong to pregnancy only and the morbidity is 5%~12%. Parts of HDCP which includes gestational hypertension,pre-eclampsia(PE),eclam psia usually lead to serious impact on pregnant woman and their babies.The gl obal morbidity of pre-eclampsia is about 3%~8% and it has been a mainly ca uses of maternal death throughout the world.The consequences of the disease l asts for long. Professors divided pre-eclampsia into “light degree” and “heavy degree” by the severity which was in order to make an investigation.In recent years, It is Dadelszen who have had an new idea of the classifi cation of PE. According to his basic research the disease was divided into the“early-onset pre-eclampsia” and the “late-onset pre-eclampsia” by 34-week of g estation age. Meanwhile,they were considerd to be totally different.The propose has been widely supported.Valensise insists that the “early-oneset pre-eclampsi a” is a placenta-related disease which originated from the first trimester.It means that the shallow placenta-implantation dues to the failed invasion of trophob lastic cells is the key factor of the “early-onset PE”. However, the “late-onset pre-eclampsia” has motivated by maternal-related factors( such as weight、hyper glycemia ect). Lisonkova considers that the morbidity and mortality of early-on eset PE is higher than that of late-onset PE. To study the rationality of the sp ecial classification and to make a deep impression of the severe disease, we c ollected medical history,general information,clinical information,examination data of all the qualified cases from the second affiliated hospital and divided them into early-onset groups and late-onset group by 34-gestational age. Objective:Comparative analysis was applied to find out the difference between on clinical manifestations,maternal and perinatal outcomes between the “early-onset severe pre-eclampsia” and the “late-onset severe pre-eclampsia”. In order to understanding the disease as well as we can. Data and methods: 1.Data:199 cases of singleton pregnancy patients complicated by the severe P E who was admitted to The Second Affiliated Hospital of Zhengzhou from M arch of 2013 to March of 2015. They were divided into two groups by 34-ges tational age as follow:(1) Early-onset severe pre-eclampsia group(early-onset group):89 cases of pregnant women who was diagnosed before the 34-gestational age [ These pati ents were divided again by expectant care or not into expectant management g roup(48cases) and un-expectant management groups(41cases) ](2) Late-onset severe pre-eclampsia group(late-onset group):110 cases of g ravidas who were diagnosed after the 34-gestational age.The screening criteria of samples obeyed these requirements:singleton,no n-complication on pregnancy(chronic internal or surgery medicine complication,s uch as: liver diseases,thyroid disorders,glomerulonephritis,underlying cardiac-dise ases,systemic lupus erythematosus),Excluding the ones whose records was inco mplete.Diagnostic criteria:reference to the 8th edition of 《Obstetrics and Gynecol ogy》which was published by People’s Medical Publishing House. 2.Methods:Observation and recording: Demographic characteristics of pregnant women:age,the number of pregnancy and accouchement,standard of culture;physical sign and medical history:blood pressure,hospitalized gestational age,termination of pregnancy,history of pre-eclampsia; examinations: 24 h quantitative of urine protein,fundus examination,S/D value of umbilical artery,liver function,renal function); maternal complications: FGR,placental abruption,HELLP syndrome,hepatosis,renal dysfunction,hypoproteinemia,ascitic fluid,cardiac failure,postpartum hemorrhage,eclampsia,Disseminated Intravascular Coagulation、Multiple Organ Dysfunction Syndrome、ICU admission; expectant management(yes or not and the lasting time);Perinatal complications: Apgar score,length of stay in hospital,neonatal respiratory distress syndrome,necrotizing enterocolitis of newborn,scleredema of newborn,neonatal infection,MODS of newborn,fetal death,stillbirth,neonatal death,asphyxia neonatorum.Description:(1)Enumeration data described in percentage,measurement data described in( X ±S) or M.(2) The data were analyzed by SPSS22.0 and P<0.05 were defined as statistical significance. Results:1. Demographic information: The comparison of the early-onset group and late-onset group as while as the comparison of the expectant management group and the nu-expectant management group proved that maternal age,degree of education between the groups were non-statistical significance(P>0.05).2.(1) Clinical general data comparison:blood pressure( both systolic blood pressure and diastolic blood pressure)in early-onset group was higher than that of the late-onset group.Hospitalization time and termination age of pregnancy were earlier than the late-onset group,they were statistical significance(P<0.05).(2)Medical history:history of pre-eclampsia in the early-onset group was higher than that in the late-onset group, it was statistical significance(P<0.05)(3) Maternal complications:morbidity of ascitic fluid(31.4%),hypoproteinemia(44.9%), clinical symptoms of pre-eclampsia(22.3%),fundus examination in the early-onset groups(32.6%),proportion of FGR(21.3%) were higher than that of the late-onset group,all the comparisons were statistical significance(P<0.05).(4)Serious complications of pregnant women:Proportion of HELLP syndrome(10.1%),combined kidney-liver damage(19.1%),ICU admission(20.2%) in the early-onset groups was higher than that of the late group,it were statistical significance(P<0.05);There were 56 cases of single-organ involvement and 14 cases of double-organs involved in the early-onset group.The corresponding number was 28 and 4 in the late-onset group.Proportion of renal dysfunction,cardiac failure,postpartum hemorrhage in the early-onset group was equal to that of the late group,it was non-statistical significance(P>0.05).(5)Effect of expectant management:Proportion of neonatal death,serious complications of neonatal was lower than that in the un-expectant management group,it were statistical significance(P<0.05). Length of stay in hospital of pregnant women was longer than that of the un-expectant management group. it was statistical significance(P<0.05). Proportion of serious complications of pregnant women,length of stay in hospital of neonatals,neonatal asphyxiain of the expectant management group was equal to un-expectant management group,it was non statistical-significance(P>0.05).3.(1) Proportion of neonatal death was about 14.6%(29 /199) of all the cases;Birth weight of the early-onset group was lighter than that of the late-onset group;Length of stay in hospital of neonatal longer than that of late-onset group; Fetal death,induced labour,neonatal death in the early-onset group were higher than that of the late-onset group,it was statistical significance(P<0.05)(2)Percentage of preterm labor of each group was 100% and 67.4%. Percentage of asphyxia neonatorum(19.1%),NICU admission(39.3%),serious complications of newborns(47.2%) in the early-onset group were higher than that of the late-onset group,it was statistical significance(P<0.05).(3)Percentage of intrauterine distress(21.3%),elevated S/D values of umbilical artery(19.1%) which was defined above 3.0 of the early-onset group were higher than that of the late-onset group,it was statistical significance(P<0.05). Conclusions:1. Women with a history of pre-eclampsia seams more likely to have early onset severe pre-eclampsia in the next pregnancy. Perinatal care in early-onset group needs strengthen.2. It was the single-organ damage dominantly in sever pre-eclampsia. Proportion of general complications and serious complications of the early-onset pre-eclampsia were higher than that of the late-onset sever pre-eclampsia. Proportion of perinatal outcome in early-onset group were more worse than that of the late-onset group. Which was even worse in those ones who have had an elevated S/D values(>3.0) of umbilical artery.3. Expectant treatment could improve birth weight,at the same time, decrease the proportion of neonatal death and serious complications of neonatal infants.The proportion of serious complications of pregnant women was steady. |
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