Analysis Of Clinical Outcomes Of Patients With Early Onset Preeclampsia Treated With Low Molecular Weight Heparin

ObjectivePreeclampsia(PE)is a serious pregnancy complication,and it is one of the main causes of increased mortality in pregnant and perinatal infants.Preeclampsia that occurs before 34 weeks of pregnancy is called early-onset,which has the characteristics of early onset,rapid progress,many complications,and poor mother-to-child outcomes.It can only be cured by terminating pregnancy.However,premature termination of pregnancy reduces the perinatal survival rate significantly.At present,it is believed that under the circumstances of ensuring the safety of mothers and infants,appropriate expectant treatment can be performed to extend the gestational week,in order to improve perinatal outcomes.At present,the pathogenesis of preeclampsia is not completely clear,and it may be related to insufficient remodeling of uterine spiral arterioles,excessive activation of inflammatory immunity,damage to vascular endothelial cells,and damage to oxidative stress.At present,it is generally believed that insufficient remodeling of uterine spiral arterioles is the key to preeclampsia.In addition,some studies have shown that patients with preeclampsia may present pathological hypercoagulable states due to vascular endothelial damage,platelet activation,and lack of anticoagulation factors,resulting in adverse pregnancy outcomes.Low molecular weight heparin(LMWH)is an anticoagulant.Some studies believe that it can improve the maternal and infant outcomes of patients with preeclampsia through anticoagulation,and it is safer to use during pregnancy.Therefore,low molecular weight heparin has been widely used in the prevention and treatment of preeclampsia in recent years.However,with the in-depth study of related mechanisms,some studies have found that in addition to anticoagulant and antithrombotic effects,low molecular weight heparin can also improve placental blood perfusion through anti-inflammatory,protection of vascular endothelial cells,and regulation of proliferation and apoptosis of placental trophoblast,which can improve the prognosis of mothers and infants in patients with preeclampsia.Previous studies have shown that the application of low molecular weight heparin from 12 to 16 weeks of gestation in pregnant women with a history of preeclampsia can reduce the recurrence rate of preeclampsia,prolong the gestational age,and improve the outcome of mother and child.This indicates that the prophylactic application of low molecular weight heparin is beneficial to early onset preeclampsia.However,in clinical practice,there are still some pregnant women with early onset preeclampsia who did not use low molecular weight heparin prophylactically before diagnosis.Therefore,whether the therapeutic application of low molecular weight heparin after the diagnosis of early onset preeclampsia is effective still needs further exploration.This study retrospectively analyzes the clinical effect of 48 patients with early onset preeclampsia treated with low molecular weight heparin,in order to explore the clinical value,deepen our understanding of the clinical efficacy of low molecular weight heparin and provide a reference for the early onset preeclampsia clinical treatment.Materials and MethodsThe clinical data of 95 patients with early onset preeclampsia who terminated pregnancy in the obstetrics department of the First Affiliated Hospital of Zhengzhou University were included.According to whether low-molecular-weight heparin is used after the diagnosis of early onset preeclampsia and before termination of pregnancy,it is divided into a low molecular weight heparin treatment group(48 cases)and a conventional treatment group(47 cases).In most randomized controlled trials,the application time of low molecular heparin is not less than one week,so in this study the heparin treatment group was further divided into a group of low molecular heparin application time? 7 days(22 cases)and a group of low molecular heparin application time<7 days(26 cases).Before admission,patients underwent regular prenatal check-ups in our hospital or local hospital.After diagnosis of preeclampsia,antihypertensive drugs were regularly applied and blood pressure and urine routine were regularly monitored.Due to differences in individual compliance and economic and cultural levels,there are certain differences in the duration of application of low molecular weight heparin in different patients.The application of low molecular weight heparin in some patients began after the outpatient diagnosis of early onset preeclampsia,and the rest of patients began after admission.When the patient's condition progressed and there was an indication of hospitalization,she was admitted to our hospital through outpatient.After admission,the patients were given routine obstetric care and drug intervention.The specific measures were:the conventional treatment group was given rest,sedation,antispasmodic,and antihypertensive treatment.At the same time,the state of pregnant women and fetuses were closely monitored and symptomatic treatment was actively given.The low molecular weight heparin treatment group added or continued to use low molecular weight heparin on the basis of the conventional treatment group,and discontinued low molecular weight heparin 12 to 24 hours before termination of pregnancy.Record delivery gestational weeks,prolonged pregnancy,incidence of maternal complications(including cardiac insufficiency,placental abruption,HEELP syndrome,pleural and peritoneal effusion,hypoalbuminemia,liver and kidney injury,etc.),and apgar scores of newborn(1 minute,5 minutes),neonatal birth weight,and the incidence of neonatal asphyxia and fetal intrauterine distress.Results1.There were no significant differences in delivery gestational weeks,prolonged pregnancy,incidence of maternal complications(including cardiac insufficiency,placental abruption,HEELP syndrome,pleural and peritoneal effusion,hypoalbuminemia,liver and kidney injury,etc.),and apgar scores of newborn(1 minute,5 minutes),neonatal birth weight,and the incidence of neonatal asphyxia and fetal intrauterine distress between the low molecular weight heparin treatment group and the conventional treatment group(all P>0.05).2.There were no significant differences in delivery gestational weeks,prolonged pregnancy,incidence of maternal complications(including cardiac insufficiency,placental abruption,HEELP syndrome,pleural and peritoneal effusion,hypoalbuminemia,liver and kidney injury,etc.),and apgar scores of newborn(1 minute,5 minutes),neonatal birth weight,and the incidence of neonatal asphyxia and fetal intrauterine distress between the low molecular heparin application time>7 days group and the low molecular heparin application time<7 days group(all P>0.05).3.There were no significant differences in delivery gestational weeks,prolonged pregnancy,incidence of maternal complications(including cardiac insufficiency,placental abruption,HEELP syndrome,pleural and peritoneal effusion,hypoalbuminemia,liver and kidney injury,etc.),and apgar scores of newborn(1 minute,5 minutes),neonatal birth weight,and the incidence of neonatal asphyxia and fetal intrauterine distress between the low molecular heparin application time>7 days group,the low molecular heparin application time<7 days group and the conventional treatment group(all P>0.05).Conclusion1.The addition of low molecular weight heparin to the routine treatment of patients with early onset preeclampsia can not prolong the pregnancy time,does not improve the maternal and infant outcome.2.In clinical practice,there is a difference in the length of low molecular weight heparin application in patients with early onset preeclampsia.However,the length of application time may have no significant effect on the efficacy of low molecular weight heparin,and none of them significantly improves the outcome of mother and infant.