Affecting Factors Analysis Of Maternal Vascular Malperfusion In Preeclampsia

Objective:To summarize the clinical characteristics of preeclampsia and explore the affecting factors of placental maternal vascular malperfusion(MVM)in preeclampsia.Methods:Analyze the clinical characteristics of 705 cases(include 598 cases with placental pathological results)of hospitalized patients with preeclampsia in Jinan maternity and child care Hospital since July 2018 to July 2020.The data of clinical characteristics was collected by big data platform.The data include the general situation of patients(age,weight,gestational week upon the occurrence of elevated blood pressure,gestational age at delivery,family history of hypertension,history of hypertension in previous pregnancy,parity,number of fetus,mode of delivery,birthweight,and Apgar scores),hypotensor(nifedipine,labetalol),clinical indicators(systolic blood pressure,diastolic blood pressure,alanine transaminase,aspartate transaminase,albumin,total bile acid,glycocholic acid,total bilirubin,direct bilirubin,indirect bilirubin,uric acid,creatinine,urea nitrogen,24-hour urine protein determination,serum potassium,serum sodium,serum calcium,serum magnesium,white blood cell,hemoglobin,platelet,D dimer,activated partial thromboplastin time,prothrombin time,fibrinogen,B type natriuretic peptide),placental pathology(placental MVM,placental fetal vascular malperfusion(FVM),Placental inflammatory lesions).Grouping criteria:control group(n=348 cases):preeclampsia without MVM;MVM Group(n=250 cases):preeclampsia with ?chronicity of infarction or ?distal villous hypoplasia or ? accelerated villous maturation or?decidual arteriopathy.The affecting factors of placental MVM in preeclampsia were retrospectively analyzedResults:(1)Among the patients with preeclampsia,the mean maternal age was(3 1.90±5.39)years,the mean weight was(81.16± 13.28)kg,the mean gestational week upon the occurrence of elevated blood pressure was(33.89±4.52)weeks,the mean gestational age at delivery was(36.53±2.92)weeks.188 cases(26.7%)had family history of hypertension,17cases(2.4%)had history of hypertension in previous pregnancy.There were 442 primigravidas(62.7%),648 singleton pregnancies(91.9%),cesarean delivery 553 cases(78.4%),mean newborn birthweight(2736±849)g and Apgar scores(8.57±1.71)points,(if twins)newborn 2 birthweight(2206±530)g and Apgar scores(8.91±0.34)points.(2)Among the patients with preeclampsia,the mean systolic blood pressure at delivery was(151.95± 14.60)mmHg,the mean diastolic blood pressure at delivery was(93.87±11.60)mmHg.The mean laboratory test results were alanine Aminotransferase(35.23± 196.83)U/L,aspertate aminotransferase(47.50±349.02)U/L,albumin(29.26±3.62)g/L,total bile acid(5.46±9.91)?mol/L,glycocholic acid(3.01±5.56)mg/L,total bilirubin(7.57±15.00)?mol/L,direct bilirubin(3.42±6.01)?mol/L,indirect bilirubin(3.71 ±4.04)?mol/L,uric acid(406.91 ± 105.46)?mol/L,creatinine(54.82± 16.46)?mol/L,urea nitrogen(4.65± 1.97)mmol/L,24-hour urine protein determination(2614.84±4232.44)mg/L,serum potassium(4.16±0.48)mmol/L,serum sodium(137.64±2.70)mmol/L,serum calcium(2.43±5.77)mmol/L.serum magnesium(1.39±7.04)mmol/L,white blood cells(1 1.74±5.07)109/L,hemoglobin(112.00± 15.58)g/L,platelets(175.40±57.43)109/L,D dimer(2.36±4.15)mg/L,prothrombin time(11.37±2.25)s,activated partial thromboplastin time(28.43±5.45)s,fibrinogen(4.35±2.22)g/L,B-type natriuretic peptide(92.68± 126.23)ng/L.(3)In this study,598 cases had placental pathological results.Among them,the number of MVM was 250(41.9%),the number of FVM was 12(2.0%),the number of placental inflammatory lesions was 67(11.2%).(4)Compared with the control group,the MVM group showed reductions in gestational week upon the occurrence of elevated blood pressure(34.10±4.42,33.24±4.52)weeks,gestational age at delivery(36.74±2.81,35.88±2.87)weeks,birthweight(2775.10± 818.59,2576.08±848.55)g,with statistically significant differences(P<0.05).(5)Compared with the control group,the MVM group showed increases in diastolic pressure(93.24±11.81,95.61±11.33)mmHg,total bile acid(4.69±7.93,6.78± 13.25)?mol/L,glycocholic acid(2.65±4.75,3.75±7.3 1)mg/L,direct bilirubin(2.98±2.17,4.26±9.52)?mol/L,uric acid(399.32±93.46,421.74± 116.65)?mol/L,urea nitrogen(4.50± 1.59,4.90±2.31)mmol/L,24-hour urine protein determination(2318.47±3536.92,3386.96±5220.17)mg/L,serum magnesium(0.97±0.28,1.07±0.3)mmol/L,white blood cell(11.46±3.42,12.05±3.59),while reductions in album(29.53±3.64,28.66±3.48)g/L,serum sodium(137.97±2.71,137.29±2.71)mmol/L,serum calcium(2.14±0.18,2.10±0.18)and platelet(177.44±58.28,167.29±56.14)109/L,with statistically significant differences(P<0.05)(6)The results of binary Logistic regression showed that albumin(OR value=0.907,95%CI:0.823-0.999)was an independent protective factor for maternal vascular malperfusion in preeclampsia,total bile acid(OR value=1.136,95%CI:1.006-1.284)was an independent risk factor for maternal vascular malperfusion in preeclampsia,with statistically significant differences(P<0.05)Conclusion:(1)MVM in preeclampsia patients may be associated with gestational week upon the occurrence of elevated blood pressure,gestational age at delivery,diastolic blood pressure,total bile acid,glycocholic acid,direct bilirubin,uric acid,urea nitrogen,24 h urine protein determination,serum magnesium,white blood cell,albumin,serum sodium,serum calcium and platelets.(2)Albumin is an independent protective factor for MVM in preeclampsia while total bile acid is an independent risk factor for MVM in preeclampsia patients.