| ObjectiveAnalyze and compare the clinical test results and maternal and infant outcomes of women with Preeclampsia(PE)combined with and without Fetal growth restriction(FGR).To investigate whether the clinical manifestations of PE patients combined with FGR were more serious and whether the adverse outcomes of mothers and infants were worse.At the same time,by comparing the differences in the pathological changes of maternal placenta between the two groups,we analyzed whether more serious lesions occurred in the maternal placenta in the case of PE combined with FGR,and explored the correlation between the severity of maternal placenta lesions and adverse outcomes of mothers and infants..MethodThe subjects of this study were singlet pregnant women with pure PE who were admitted to the Department of Obstetrics of the Third Affiliated Hospital of Guangzhou Medical University and gave birth from January 2019 to June 2022.During the study period,there were a total of 1189 cases complicated with PE.A total of 935 cases of twin pregnancy,maternal complicated with chronic hypertension,endocrine system diseases,autoimmune system disorders,and fetal complicated with chromosomal diseases or fetal malformations were excluded.Among the remaining254 cases,106 cases of incomplete clinical data or placental pathological data were excluded.The final remaining 148 patients with PE were enrolled.The enrolled women were at least 18 years old,gestational age was at least 24 weeks,and had no history of drug abuse or smoking.According to whether PE combined with FGR or not,PE was divided into two groups: 44 cases in PE combined with FGR group and104 cases in PE not combined with FGR group.Clinical data of the two groups of pregnant women were collected,including clinical laboratory test results,maternal-fetal outcome and pathological changes of maternal placenta.A retrospective comparative analysis method was used to analyze the test results,pregnancy outcome and the differences in pathological changes of maternal placenta between the two groups of women with PE combined with FGR and PE without FGR.t test or χ~2 test were used for data processing.The measurement data were expressed as mean ±standard deviation,and the count data were expressed as case number and percentage.At 0.05,the difference is considered significant and statistically significant.Results1.Among the 148 pregnant women with PE,44 cases(29.73%)were in the FGR group and 104 cases(70.27%)were in the non-FGR group.The proportion of preexisting hypertension or FGR history in the FGR group was higher than that in the non-FGR group [11.4%(5/44)vs.2.9%(3/104),4.6%(2/44)vs.0%(0/104)].The proportion of puerpera in the PE group combined with FGR was higher than that in the group without FGR [61.4%(27/44)vs.37.5%(39/104)],and the differences were statistically significant(all P < 0.05).2.The results showed that compared with PE patients without FGR,platelet count,24 h urinary protein quantity,uric acid and blood creatinine levels were increased in patients with FGR,while alanine aminotransferase,prothrombin activity,fibrinogen and other data were decreased in patients with FGR.The systolic blood pressure of patients with PE and FGR before admission was also lower than that of patients without FGR,and these results were statistically significant(all P < 0.05).There was no significant difference between partial thrombin time and prothrombin time.3.Among the 148 PE pregnant women,there were 12 cases of placental abruption(8.33%),9 cases of HELLP syndrome(6.25%),9 cases of abnormal liver function(6.25%),13 cases of abnormal kidney function(9.03%),10 cases of heart failure or pulmonary edema(6.94%),10 cases of chest and abdominal effusion(6.94%).There were 24 patients(16.22%)with hypoproteinemia,and 13 patients(9.03%)were transferred to ICU after delivery.The incidence of most common maternal complications was higher in the PE group with FGR than in the group without FGR,especially in the incidence of hypoproteinemia.The probability of hypoproteinemia in PE combined with FGR group was significantly higher than that in the non-FGR group [29.55%(13/44)vs.10.58%(11/104)](χ~2 value =8.188,P=0.004),and the difference was statistically significant(P < 0.05).The incidence of abnormal liver function,abnormal kidney function and chest and abdominal effusion in patients with FGR was higher than that in patients without FGR,but there was no statistically significant difference(P > 0.05).There was no significant difference in the incidence of heart failure or pulmonary edema and the probability of postpartum ICU transfer between the two groups.4.Among 148 women with PE,44 cases of fetal growth restriction(29.7%),87 cases of premature delivery(58.7%),24 cases of mild asphyxia(16.2%),2 cases of severe asphyxia(1.3%),6 cases of stillbirth(3.9%)and 39 cases of fetal distress(26.3%)occurred in perinatal infants.Among them,The probability of < 34 weeks preterm delivery,< 37 weeks preterm delivery and neonates admitted to the neonatology department were higher in the PE group combined with FGR than in the non-FGR group [59.1%(26/44)vs.40.4%(42/104),79.5%(35/44)vs.50%(52/104)and 86.4%(38/44)vs.46.2%(48)/104)];The birth weight of newborns in the FGR group was lower than that in the non-FGR group [(1434.55±536.40)g vs.(2288.65±976.71)g,t= 5.456],and the differences were statistically significant(all P< 0.05)5.Comparison of placental weight and placental coefficient between PE with and without FGR: The placental weight of the FGR group was significantly lower than that of the non-FGR group [(345.93±101.06)g vs.(436.78±125.70)g,t= 2.246].The placental coefficient(placental coefficient = placental weight/birth weight)in the FGR group was higher than that in the non-FGR group [(0.26±0.09)vs.(0.21±0.075),t=3.181],and the differences were statistically significant(all P < 0.05).6.Comparison of placental histopathological changes between PE group with and without FGR: The probability of placenta occurrence of decidua,villi overmaturity,distal villi dysplasia and syncytic nodules in the FGR group was significantly higher than that in the non-FGR group [ 61.4%(27/44)vs.32.6%(34/104),65.9%(29/44)vs.38.5%(40/104),59.1%(26/44)vs.24.0%(25/104),95.5%(42/44)vs.62.5%(65/104)],The differences were statistically significant(all P < 0.05).Although the incidence of placental infarction was less than 10% different between the two groups,multifocal and large infarcts were dominant in the group with FGR,while focal infarcts were dominant in the group without FGR.The incidence of fetal vascular malperfusion in placenta with FGR was higher than that without FGR [52.3%(23/44)vs.21.1%(22/104)],and the difference was statistically significant(P < 0.05).The results showed that in the case of FGR,the incidence of placental lesions increased significantly,and the degree of lesions became more severe,resulting in not only maternal vascular malperfusion,but also fetal vascular malperfusion.ConclusionThe overall incidence of maternal complications in PE patients with FGR was higher than that in the non-FGR group,especially the increased risk of hypoproteinemia,abnormal liver and kidney function,and chest and abdominal effusion.The perinatal preterm birth and low birth weight infants were significantly increased in PE patients with FGR.The maternal placental weight of PE patients with FGR was significantly lower than that of those without FGR,and the pathological changes of placental tissue were more serious.Severe placental pathology is likely to be associated with worse perinatal adverse outcomes. |
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