| Objective:The case data of patients with early-onset severe preeclampsia were collected,and the appropriate methods were selected for data processing,and retrospectively analyzed,and the effects of cerebral placental ratio and non-stressed fetal heart rate monitoring results on maternal and infant perinatal outcomes at different termination times were analyzed,and the most suitable timing of delivery was discussed,and the results were applied clinically to improve maternal and infant pregnancy outcomes.Research content:Collect detailed case data of patients.The patient’s personal information includes name,hospital number,age,pregnancy and birth times,gestational weeks at the time of termination of pregnancy,whether liver and kidney function are abnormal,whether placental abruption occurs,whether HELLP syndrome occurs,whether eclampsia occurs,and whether placental adhesion is found;The data of newborns include: Apgar1 min score after birth,whether the newborn died,whether there was fetal distress,whether there was fetal growth restriction,and whether there was neonatal asphyxia.Research methods:The data of patients who suffered from early-onset severe pre-eclampsia who were delivered in the outpatient department of the Second Hospital of Jilin University from January 1,2017 to December 1,2022 were collected.There were 156 samples taken into the study after excluding the pregnant women with twin pregnancy,intrauterine fetal death,induced labor,and severe other obstetric complications.All the patients included in the study were terminated by cesarean section,and had been treated with hormone to promote fetal lung maturation before termination of pregnancy.The patients were divided into two groups according to the results of brain-planta ratio and non-stress fetal heart rate monitoring in the monitoring of maternal and fetal blood flow.The specific groups were: abnormal brain-planta ratio and fetal heart rate monitoring group(n=22),which were divided into three groups: gestational week<34 weeks at the time of termination of pregnancy(n=10),gestational week ≥ 34 weeks at the time of termination of pregnancy(n=12);The group with normal ratio of brain to placenta and abnormal results of fetal heart monitoring(n=33),including the group with gestational week<34 weeks at the time of termination of pregnancy(n=16)and the group with gestational week ≥ 34 weeks at the time of termination of pregnancy(n=17);The abnormal ratio of brain to placenta and normal fetal heart rate monitoring group(n=38),in which the gestational weeks were less than 32 weeks(n=9),32-34 weeks(n=14),and34 weeks or more(n=15)at the time of termination of pregnancy;Brain placental ratio and fetal heart rate monitoring were normal in the group(n=61),of which the gestational weeks were less than 32 weeks(n=15),32 weeks to 34 weeks(n=21),and34 weeks or more(n=25)at the time of termination of pregnancy.Result:1.1.Comparison of pregnancy outcomes in the normal group of cerebral placental ratio and non-stressed fetal heart rate monitoring: the age,pregnancy and birth of patients in the three groups of patients less than 32 weeks(n=15),32-34 weeks(n=21),and more than 34 weeks(n=25),with P less than 0.05 as a statistical difference,the calculation results showed that there was no statistical difference between the three groups of data;the placental abruption rate,eclampsia incidence,liver and kidney function abnormalities,placental adhesion rate,neonatal mortality rate of the three groups,The incidence of HELLP syndrome showed no statistically significant difference(P>0.05).There were significant differences in the incidence of Apgar score,fetal distress,fetal growth restriction and neonatal asphyxia at 1 min after birth between the three groups(P<0.01).After adjusting for differences between groups,there were differences between the three groups(P<0.0167),and the incidence of fetal distress,fetal growth restriction and neonatal asphyxia were higher in the group less than 32 weeks and 32 weeks to 34 weeks,and there were statistical differences(P’<0.0167).Compared with the 32-week group,the incidence of fetal distress and fetal growth restriction were not statistically significant(P’>0.0167).The incidence of neonatal asphyxia was higher in the group less than 32 weeks and was statistically significant(P<0.0167).Adjusted comparison between groups with Apgar score at 1 min postnatal period: P=0.000 in the group less than 32 weeks and 32 weeks to 34 weeks;P=0.000 between the group at 32 weeks to 34 weeks and group greater than 34 weeks;P=0.000 between groups with less than 32 weeks and groups greater than 34 weeks;P=0.500 in the group with fetal distress;P=0.500 in the group with less than 32 weeks to 34 weeks;P=34 weeks in the group from 32 weeks to 34 weeks 0.013;P=0.001 between groups less than 32 weeks and groups greater than 34 weeks;adjusted comparison between groups with fetal growth restriction: P=0.090 in groups less than 32 weeks and 32 weeks to 34 weeks;P=0.016 between groups at 32 weeks to 34 weeks and groups greater than34 weeks;P=0.000 Corrected comparison between groups with neonatal asphyxia:P=0.000 between groups with neonatal asphyxia: P= 0.016;P=0.016 between the 32-34 week group and the group greater than 34 weeks;P=0.000 between the group less than 32 weeks and the group greater than 34 weeks;Corrected comparison between groups of fetal growth restriction: P=0.090 in the group of less than 32 weeks and the group of 32-34 weeks;Comparison between the 32-34 week group and the group over34 weeks: P=0.016;Comparison between the less than 32 weeks group and the more than 34 weeks group: P=0.000 correction comparison between the neonatal asphyxia groups: P=0.016 between the less than 32 weeks group and the 32-34 weeks group;Comparison between the 32-34 week group and the group over 34 weeks: P=0.016;Comparison between groups less than 32 weeks and more than 34 weeks: P=0.0002.Comparison of pregnancy outcomes in the group with abnormal cerebral placental ratio and normal non-stressed fetal heart rate monitoring: the age,pregnancy and birth time of patients in the three groups of patients with abnormal cerebral placental ratio and non-stressed fetal heart rate monitoring: the age,pregnancy and birth time of patients in the three groups of patients less than 32 weeks(n=9),32 weeks to34 weeks(n=14),and P less than 0.05 as the statistical difference,the calculation results showed that there was no statistical difference between the three groups of data groups;the rate of placental abruption,the incidence of HELLP syndrome,the incidence of eclampsia,the incidence of abnormal liver and kidney function,and the incidence of placental adhesions in the three groups,The results showed that there were no significant differences(P>0.05),there were no significant differences in neonatal mortality and fetal distress between the three groups(P>0.05),and there were significant differences in Apgar score,fetal growth restriction and neonatal asphyxia at1 min after birth(P<0.01).The incidence of fetal growth restriction and neonatal asphyxia in the group less than 32 weeks was higher than that in the 32-34 weeks group and greater than 34 weeks(P’<0.0167),and the 1min Apgar score in the group less than32 weeks was significantly lower than that in the 32-34 weeks group and greater than34 weeks.Compared with the 32-week to 34-week group,there were no significant differences in the 1 min Apgar score,fetal distress,fetal growth restriction,and neonatal asphyxia in the group greater than 34 weeks(P’>0.0167).Adjusted comparison between the two groups with Apgar score at 1 min of birth: P=0.000 in the group less than 32 weeks and 32 weeks to 34 weeks;P=0.697 between the group at 32 weeks to 34 weeks;P=0.000 between groups with less than 32 weeks and groups greater than 34 weeks;P=0.013 between groups with fetal growth restriction: P=0.013 in the group less than32 weeks and 32 weeks to 34 weeks;P= 0.651;P=0.003 between groups less than 32 weeks and groups greater than 34 weeks;comparison between groups with neonatal asphyxia: P=0.001 in group less than 32 weeks and 32 weeks to 34 weeks;P=0.598 in groups with groups less than 32 weeks and groups greater than 34 weeks;P=0.000 in groups less than 32 weeks and groups greater than 34 weeks3.Comparison of pregnancy outcomes in the group with normal cerebral placenta ratio and non-stressful fetal heart rate monitoring: age,pregnancy and birth time of patients in the group less than or equal to 34 weeks(n=16)and the group greater than34 weeks(n=17),with P less than 0.05 as the statistical difference,the calculation results indicate that there is no statistical difference between the two groups of data;the rate of placental abruption,the incidence of HELLP syndrome,the incidence of eclampsia,the incidence of liver and kidney function abnormalities,and the incidence of placental adhesions in the two groups,The results showed no significant difference(P>0.05),and there were no significant differences in neonatal Apgar score,neonatal mortality,fetal distress rate,fetal growth restriction rate and fetal asphyxia rate at 1 min after birth between the two groups(P>0.05)4.The cerebral placental ratio and non-stressed fetal heart rate monitoring were abnormal: less than or equal to 34 weeks group(n=10),greater than 34 weeks group(n=12).The age,pregnancy and parity of the two groups were statistically different with P less than 0.05,and the calculation results showed that there was no statistical difference between the two groups,and there was no significant difference in placental abruption,HELLP syndrome,eclampsia,liver and kidney dysfunction,and placental adhesion rate between the two groups(P>0.05).The results showed no significant difference(P>0.05)Conclusion:1.Clinically,the timing of termination of pregnancy in early onset severe preeclampsia should be selected,and sufficient attention should be paid to the results of fetal brain placental ratio and non-stress fetal heart rate monitoring.The appropriate time should be selected to terminate pregnancy according to the specific situation,and the preoperative preparation should be fully made to reduce the perinatal outcome of poor mothers and infants.2.For patients with normal brain placental ratio and non-stress fetal heart rate monitoring,termination of pregnancy after 34 weeks of pregnancy will lead to better perinatal outcomes for the pregnant women and newborns;3.Patients with early-onset severe pre-eclampsia with an abnormal cerebral placental ratio and normal fetal heart rate monitoring should terminate the pregnancy after 32 weeks’ gestation,and prolonging the continuation of pregnancy does not improve maternal and infant pregnancy outcomes.In this study,due to the small number of enrolled cases(n=38),there may be a lack of representativeness of the sample population,and large sample analysis is required for further verification.4.For patients with early-onset severe preeclampsia with normal brain placenta and abnormal fetal heart monitoring without stress,if the fetal heart monitoring results have not been significantly improved after adequate fetal heart correction measures have been given,pregnancy should be terminated as soon as possible after the treatment of promoting fetal lung maturity.5.For patients with early-onset severe preeclampsia who have abnormal brain placental ratio and non-stress fetal heart monitoring,if the fetal heart monitoring results still indicate abnormalities after taking measures such as lateral lying position and oxygen inhalation,the pregnancy should be terminated immediately. |
PDF Full Text Request