Clinical Analysis Of Hypertensive Disorder Of Pregnancy Complicated With Nervous System Diseases

Objective:We retrospectively analysed the clinical data of some patients who got hypertensive disorder of pregnancy complicated with nervous system diseases,to summarise the clinical characteristics,pregnancy outcome,treatment and prognosis.Through these data,we will explore hypertensive disorder of pregnancy complicated with cerebral diseases related risk factors,identify different types of diagnosis,analyse the reasons of missed diagnosis and misdiagnosis to provide a reference basis for clinical work.Methods:A retrospective analysis was conducted on 51 patients with hypertensive disease of pregnancy complicated with nervous system diseases admitted to a hospital in Changchun from January 2013 to December 2018.The patients were divided into groups according to disease types: group A,hypertensive disease of pregnancy complicated with reversible posterior leucoencephalopathy syndrome(23 cases);group B,hypertensive disease of pregnancy complicated with cerebrovascular diseases(28 cases);At the same time,57 cases of patients with hypertensive disease of pregnancy who were hospitalized during the same period and excluded from nervous system diseases after imaging examination were selected as group C.The general situation,clinical and imaging manifestations,pregnancy and perinatal outcomes,treatments and prognosis of the patients were analyzed and systemically summarized to provide references for related problems.Results:?General information: the average age of group B was significantly higher than that of group C,and the difference was statistically significant(p<0.01).There were no statistical differences in age,gravidity,parity and BMI between the other groups.The gestational weeks of admission,gestational weeks of morbidity and gestational weeks of delivery in group A and group B were all smaller than those in group C,and the length of stay was much longer than that in group C,with statistically significant differences(p<0.05).The incidence of early onset HDP(<34 weeks)and irregular antenatal care rate in group A and group B were significantly higher than those in group C,with statistically significant differences(p<0.05).In group B,6 patients(21.4%)had chronic hypertension with preeclampsia(or eclampsia).There was no significant difference between group A and group B in above(p>0.05).? Clinical manifestations: in terms of the first symptoms,headache and seizure were the most common first symptoms in group A;headache and part of neurological dysfunction were the most common first symptoms in group B.In terms of neurological symptoms,seizures were the most common in group A according to the frequency.This was followed by increased intracranial pressure,visual impairment,disturbance of consciousness,and part of nervous system dysfunction.Group B showed increased intracranial pressure,followed by part of neurological dysfunction,seizures,confusion,visual impairment,and other manifestations.Imaging manifestations: group A included 20 cases of parietal lobe involvement,18 cases of occipital lobe,13 cases of frontal lobe,10 cases of basal ganglia area,8 cases of temporal lobe,6 cases of radial crown,2 cases of corpus callosum and 1 case of thalamus.Group B included 4 patients with HDP complicated with cerebral venous sinus thrombosis(CVST)(including 1 patient with concurrent cerebral hemorrhage and cerebral infarction),6 patients with HDP complicated with cerebral hemorrhage(ICH),and 18 patients with HDCP complicated with cerebral infarction(IS).The patients with CVST,2 cases underwent DSA examination and 2 cases were confirmed by MRV,among which 3 cases were superior sagittal sinus thrombosis and 1 case was left transverse sinus thrombosis.All the patients with ICH were confirmed by CT,including 2 patients with the hemorrhage located in the brain stem,1 patient in the left basal ganglia region,1 patient in the right basal ganglia region,1 patient in the left parietal lobe,1 patient in the right temporal lobe,3 patients with a blood loss of 5-10 ml and 3 patients with a blood loss of 10-50 ml.All patients complicated with IS were confirmed by CT/MRI examination,including 11 cases of multiple lacunar infarction,2 cases of frontal lobe infarction,2 cases of occipital lobe infarction,2 cases of right basal ganglia cerebral infarction,and 1 case of left basal ganglia cerebral infarction.In terms of blood pressure,systolic blood pressure of group A was significantly higher than that of group B and C,and the difference was statistically significant(p<0.05),while the difference between the other three groups was not statistically significant(p>0.05).There were 7 patients combined with HELLP syndrome in combination A,3 in group B and 1 in group C.? Treatment and prognosis: cesarean was the main method for delivery in group A,group B and group C.The emergency operation rate of group A and group B was significantly higher than that of group C,and there was a significant difference between the three groups(p<0.01).About 1/3 of patients in group A and group B were transferred to ICU for comprehensive treatment and there was no statistical difference in ICU transfer rate between the two groups.Above all of the patients after treatment,A group of 21 patients were cured,there were 3-12 months without a seizure by telephone follow-up,1 case of headache patient,1 case of patients with sequela.Lesions disappeared basically by reviewing MRI.Mild patients can find basic normal imaging after 1 week,1 case of severe patients completed with bilateral basal ganglia cerebral infarction,the average recovery time of imaging was 20.17 ± 10.58 days;Three cases in group B gave up treatments,14 patients recovered after active treatments,8 patients left with varying degrees of neurological damage,and 3 patients died of cerebral hernia.The difference in prognosis between the two groups was statistically significant(p<0.01).? Pregnancy and perinatal outcomes: the incidence of adverse pregnancy outcomes in group A and group B was significantly higher than that in group C,with statistically significant differences(p<0.01).The apgar score in 1/5 minutes and the weight of newborns of group A and group B was significantly lower than those of group C.The length of hospitalization of the newborn was longer than that of group C,and the difference was statistically significant(p<0.05).There was no significant difference in the rate of neonatal transfer to neonatal department(p>0.05).All the newborns survived except stillbirth and induced labor.There was no significant difference between group A and group B in the above aspects(p>0.05)Conclusion: hypertensive disorder of pregnancy completed with nervous system diseases are rare and serious complications in pregnancy,which are characterized by acute onset,serious illness,adverse pregnancy outcome and irreversible neurological damage.Elderly patients with gestational hypertension,gestational age <34 weeks,no regular prenatal examination,chronic hypertension,and HELLP syndrome are more likely to combine neurological diseases.Early intervention,early diagnosis and early treatment are the basic treatment principles for hypertensive diseases complicated with neuropathy during pregnancy.