| BACKGROUNDHypertensive Disorders of Pregnancy(HDP)is a group of diseases that co-occur with pregnancy and elevated blood pressure.Its basic pathophysiology is small vessel vasospasm and vascular endothelial damage,which can cause multiple organs and systems damages.They affect the maternal and fetal safety.Although physicians have made continuous efforts in the prevention and diagnosis of hypertension during pregnancy,it is still the main reason for threatening maternal and fetal health in the world(especially in developing countries)and is the leading cause of the mortality.The etiology of hypertension during pregnancy has not been fully understood.Its pathogenesis is multi-factorial,multi-mechanism and multi-pathway.At present-day,the pathogenesis of pre-eclampsia is generally more recognized as the "two-stage theory";first stage,uterine spiral artery trophoblast remodels disorder,leading to placental ischemia,hypoxia,and release multiple placental factors;the second stage,placental factors enters into the maternal blood circulation,resulting in activation of the inflammatory immune system and vascular endothelial damage.Current research shows that various factors related to maternal and fetal are related to pregnancy-induced hypertension.The clinical manifestations of pregnancy-induced hypertension are diverse.At present-day,there is no single simple and easy way to diagnose pregnancy-induced hypertension.The diagnosis of hypertension during pregnancy is usually determined based on the medical history,persistent blood pressure>140/90 mmHg,and the presence of proteinuria.The management of patients with hypertensive disorders of pregnancy is mainly based on the severity of symptoms.In the principle of treatment of pregnancy-induced hypertension,timely termination of pregnancy is the most effective treatment.According to changes in the condition,timely and early delivery may be conducive to the control and recovery of maternal conditions,but it increases the risk of premature delivery.Premature babies are a serious challenge for clinicians.But if the pregnancy cannot be terminated in time,rapid changes and complex conditions often have extremely serious consequences.At the same time,the choice of delivery methods for patients with hypertensive disorders of pregnancy is a serious challenge for clinicians.In 2019,ACOG published guidelines for hypertension and pre-eclampsia during pregnancy.The timing and methods of terminating pregnancy are basically the same in domestic and foreign guidelines.It is emphasized that the treatment of the timing of delivery in patients with pregnancy-induced hypertension depends on the evaluation of the patient and the gestational age.The risk pros and cons of the maternal and the fetus must be weighed.The delivery method should be determined according to routine obstetric clinical factors.Some young perinatal workers,when unable to accurately grasp the delivery method,in order to avoid related complications,most of them tend to choose caesarean section,artificially leading to a series of problems such as high cesarean section rate and waste of medical resources.Therefore,we study and analyze data such as the ratio difference between cesarean section and vaginal delivery in patients with pregnancy-induced hypertension,aiming to explore the timing and methods of delivery for pregnancy-induced hypertension,and provide a reference for the precise treatment of pregnancy-induced hypertension.OBJECTIVESThe aim of this study is to evaluate the effects of different types of pregnancy-induced hypertension on the gestational age and high-risk factors on pregnancy outcomes,observe the cesarean section rate and vaginal delivery rate of women in different groups,explore the timing and methods,and provide a reference for the precise treatment of hypertension during pregnancy.At the same time,it is to add to the research literature and understanding concerning hypertensive disorders of pregnancy for Shandong University Libraries and obstetrical and scientific fields progress.METHODSA total of 290 patients with pregnancy-induced hypertension who were admitted to the Obstetrics and Gynecology Department of Qilu Hospital of Shandong University and delivered during January 2018 to January 2019 were selected.The retrospective analysis was performed.The study subjects were divided into six groups:hypertension in pregnancy(43 cases),preeclampsia(39 cases),severe preeclampsia(170 cases),eclampsia(2 cases),chronic hypertension(18 cases)Preeclampsia combined with chronic hypertension(28 cases),comparing the cesarean section rate and vaginal delivery rate of patients in different groups,exploring the effect of pregnancy-induced hypertension on the delivery method,and comparing the complications and fetal prognosis of patients in different groups for exploring the impact of the timing of delivery of hypertension during pregnancy.Use SPSS software for chi-square test and single factor data analysis.P<0.05 was considered statistically significant.RESULTSEclampsia and chronic hypertension with superimposed preeclampsia group had the highest rate of c-section(100%and 96.4%)and gestational hypertension and chronic hypertension group the lowest rate of c-section 55.8%and 66,7%respectively.The rate of c-section for preeclampsia patients was of 82.10%and 95.9%for severe preeclampsia and the difference was statistically significant(p<0.001).Delivery occurred at late preterm between 32 and 36+6 weeks of gestation in 5 groups:for gestational hypertension group(39.5%),preeclampsia group(56.4%),severe preeclampsia group(47.9%),eclampsia group(100%)and chronic hypertension with superimposed preeclampsia group(38.9%).For chronic hypertension group delivery occurred at early term between 37 to 39 weeks of gestation with a rate of 39.8%and the difference was statistically significant(p<0.001).The rate of neonatal adverse outcomes was higher in patients with severe preeclampsia.The SGA rate was higher in severe preeclampsia group(22.9%)followed by chronic hypertension with superimposed preeclampsia group(17.9%),preeclampsia group(7.7%)chronic hypertension group(5.6%),gestational hypertension group(4.7%)and the difference was statistically significant(P:0.019).Mean neonatal weight was highest for the patients with gestational hypertension(3.2±0.6)kg and lowest for severe preeclampsia patients(2.09±0.76)kg.for others groups the mean neonatal weight were(2.21±0.10)kg for chronic hypertension with superimposed preeclampsia,(2.8±0.00)kg for eclampsia,(2,86±0.71)kg for chronic hypertension and(2.90±0.9)kg for preeclampsia,p<0.001.Transfer to NICU rate of newborn was higher for chronic hypertension with superimposed preeclampsia group(75%)and severe preeclampsia group(63.5),for the others groups the rate were 28.2%for preeclampsia group,22.2%for chronic hypertension group,20.9%for gestational hypertension group and 0%for eclampsia group(P:0.729).Placenta abruption was found in around 10%of pregnant women with chronic hypertension with superimposed preeclampsia and in lower rates for other groups.Less than 5%of patients of each group had a pregnancy complicated by HELLP syndrome.CONCLUSION1.The choice of delivery method for patients with hypertension during pregnancy is related to the type of disease.Patients with eclampsia and severe preeclampsia are more suitable for cesarean section.Patients with hypertension during pregnancy and chronic hypertension can choose vaginal delivery,but cesarean section is still Is higher.2.The outcome of the newborn is related to the gestational week of delivery.The earlier the gestational week of delivery,the more likely the newborn is to have adverse complications.3.The choice of delivery time for pregnancy-induced hypertension requires a comprehensive balance of pros and cons.For patients with severe hypertension who are difficult to control,pregnancy must be terminated as early as possible.For uncomplicated hypertension,early delivery may reduce the risk of maternal delivery,but increase newborn Adverse outcomes require close monitoring and look forward to treatment. |
PDF Full Text Request