| Background and Aims: Preeclampsia is a type of hypertensive disorder complicating pregnancy.It is a pregnancy-specific complication that is a serious threat to maternal and child health.The clinical manifestations are elevated blood pressure,proteinuria,edema,abnormal liver enzymes,etc.,and the cause of this disease is not yet clear.According to the severity of the disease,we usually divide preeclampsia into mild preeclampsia and severe preeclampsia.At the end of the 1980 s,we found that preeclampsia still has completely different pathogenesis,pathological features,and clinical features.The two subtypes,bounded by 34 weeks of gestation,occurred in early preeclampsia at less than 34 weeks,and late-onset preeclampsia at more than 34 weeks.Therefore,according to the time of onset of severe preeclampsia,there are points for early-onset(onset before 34 weeks)and late-onset(onset after 34 weeks).Studies have shown that early onset preeclampsia and late-onset severe preeclampsia are significantly different in pathogenesis,clinical hazards,and treatment.So far,the pathogenesis of preeclampsia has not yet been fully elucidated,and the clinical development process and outcome of the disease has not yet been thoroughly studied,and clinically still lacks effective prevention and treatment methods.Therefore,this study will retrospectively analyze patients with severe preeclampsia who were diagnosed and treated in our hospital from January 2012 to January 2017.According to the inclusion criteria and exclusion criteria,238 of them were selected according to their gestational age.Divided into late-onset and early-onset severe preeclampsia,comparing the different types of severe preeclampsia patients on mothers and children have a different impact on clinical diagnosis and treatment that provide a theoretical basis and guidance.The role of providing a wide range of applications for improving the outcome of mother and child.Research methods:A retrospective analysis of 322 patients with severe preeclampsia at the First People's Hospital of Changde City,Hunan Province from January 2012 to January 2017 was performed.The patients were diagnosed according to the "Guidelines for the diagnosis and treatment of hypertensive disorders during pregnancy".We select 238 casesaccording to the inclusion criteria and exclusion criteria,including 116 cases of severe early preeclampsia and 122 cases of severe late preeclampsia;retrospective analysis of maternal serum lipids,D-dimer,BNP and urinary protein quantification indicators,and determination S/D ratio from fetal umbilical artery by fetal two-dimensional ultrasoud.All result wereanalyzed by SPSS16.0.result:Comparison of Laboratory and B ultrasound results(1)Plasma D-dimer levels in early onsetpreeclampsia patients(2.99±0.63 mg/l)were significantly higher than those in lateonset preeclampsia patients(1.87±0.41 mg/l),and the difference was statistically significant(p<0.05).);(2)The total cholesterol in fasting early onsetpreeclampsia women(6.25±0.73 mmol/l)was significantly higher than that in lateonsetpreeclampsia(5.66±0.46 mmol/l),andthe triacylglycerol in early onset group(2.98±0.75 mmol/l)was higher than that in late onset group(2.37±0.57mmol/l),The low-density lipoprotein in early onset group(5.73±1.02mmol/l)was significantly higher than lateonset group(5.19±0.85mmol/l),and the difference between the three groups was statistically significant(p <0.05).The high-density lipoprotein in earlyonset group(1.51±0.39mmol/l)has no significant differencecompared with lateonset group(1.46±0.24mmol/l)(p>0.05).(3)24-hour urinary protein quantitation in 24 hours urine volume of earlyonsetpreeclampsia patients(4213.52±760.23 mg/24h)was significantly higher than that of late onset group(456.24±53.65 mg/24h);The urine microalbuminof earlyonsetgroup(1842.15 ±201.56mg/L)was significantly higher than that of late onset group(1145.43±38.92mg/L),and the difference was statistically significant(p<0.05);(4)The ratio of S/D of umbilical artery blood(4.48±0.29)in earlyonsetpreeclampsia patients was significantly higher than that of lateonset(2.93±0.34),and the difference was statistically significant(p<0.05);(5)The average level of BNP in early onset preeclampsia patients was 1209.86±134.59pg/ml,and the average of the lateonset rate group was 1098.73±126.75 pg/ml.There was no significant difference(p>0.05).Comparison of maternal concurrency certificatesCompared with lateonset severe preeclampsia and early onset severe preeclampsia,earlyonset pregnant women complicated with placental abruption,coagulopathy,renal insufficiency,and HELLP syndrome were significantly increased in risk(p<0.05);The risk of eclampsia,heart failure,maternal death,postpartum hemorrhage,and postpartum hysterectomy had no significant difference(p>0.05).Comparison ofdeliverywaysThe rate of cesarean section was lower in early onsetsevere preeclampsia than that of thelateonset severe preeclampsia,and the difference was not statistically significant(p>0.05).Comparison of perinatal complicationsA comparative analysis of perinatal outcomes between early onsetsevere preeclampsiaandlateonset severe preeclampsia,showed that preterm birth,FGR,fetal distress,oligohydramnios,and stillbirth were statistically significant(p<0.05).There was no statistically significant difference in the incidence of asphyxia(p>0.05)Conclusions:(1)D-Dminer plasma levels in patients with early onset severe preeclampsia are higher than those in lateonset patients,and the risk of complications such as placental abruption,HELLP syndrome,coagulopathy,and renal insufficiency is higher in early-onset women than in late-onset groups;(2)TG and LDL were higher in patients with early-onset preeclampsia,and there was no significant difference in HDL between the two groups,indicating that severe vascular endothelial injury in patients with early onsetsevere preeclampsia leads to more serious clinical symptoms;(3)24-hour urinary protein and microalbumin were significantly higher in patients with early onset severe preeclampsia than in late-onset patients,indicating that renal impairment was more pronounced in early-onset patients;(4)The ratio of S/D in patients with early onsetsevere preeclampsia is higher than that in patients with lateonset severe preeclampsia.Premature delivery,intrauterine distress,FGR and other complications are more likely to occur in the perinatal infants of the earlyonset group.(5)BNP concentrations in early onset severe preeclampsia and late severe preeclampsia were significantly increased;(6)The way of terminate pregnancy is mainly cesarean section in the two groups,but the cesarean section rateis slightly lower in the early onset group,there was no statistical difference between the two groups. |
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