Gul Ahmet, Cebeci Altan, Aslan Halil, Polat Ibrahim, Ozdemir Aykut, Ceylan Yavuz
Maternal and Fetal Unit, Istanbul SSK Bakirkoy Women and Children Hospital, Istanbul, Turkey.
Gynecol Obstet Invest. 2005;59(2):113-8. doi: 10.1159/000082648. Epub 2004 Dec 9.
Our purpose was to find out and compare perinatal outcomes in pregnancies complicated by severe preeclampsia-eclampsia with and without HELLP syndrome.
Clinical and laboratory findings, and perinatal-neonatal outcomes of all pregnants with severe preeclampsia, eclampsia and HELLP have been prospectively recorded. Results were compared by means of Student's t test, chi2 analysis and Fisher's exact test as appropriate.
Among 367 consecutive severe preeclampsia, 106 (29%) had HELLP syndrome, 261 (71%) had severe preeclampsia and eclampsia. Mean gestational age and birth weight at delivery in severe preeclampsia without HELLP syndrome and in HELLP syndrome were 34.1 +/- 6.1 vs. 33.0 +/- 5.8 weeks (p = 0.119) and 1,886 +/- 764 vs. 1,724 +/- 776 g (p = 0.063), respectively. Comparing overall fetal mortality (4.6 vs. 10.3%, p = 0.009) and perinatal mortality (8.0% vs. 16.8%, p = 0.026) in severe preeclampsia-eclampsia and HELLP syndrome, respectively, there were statistically significant differences. But when analyses were performed according to gestational age before and after 32nd gestational week, the difference of perinatal mortality between the two groups was non-significant (p = 0.644 and p = 0.250), suggesting borderline difference. The most common contributing factor for fetal death after 32nd week was due to abruptio placenta without prenatal follow-up. Neonatal morbidity and neonatal mortality (4.8 vs. 6.3%, p = 0.905) in severe preeclampsia-eclampsia and HELLP syndrome respectively were similar and the difference was statistically nonsignificant.
Perinatal mortality and neonatal morbidity-mortality according to gestational age before and after the 32nd week were similar in HELLP syndrome compared with severe preeclampsia-eclampsia without HELLP but overall fetal mortality was higher in HELLP syndrome with no regular prenatal care.
我们的目的是找出并比较合并或未合并HELLP综合征的重度子痫前期-子痫患者的围产期结局。
前瞻性记录所有重度子痫前期、子痫和HELLP综合征孕妇的临床和实验室检查结果以及围产期-新生儿结局。根据情况采用学生t检验、卡方分析和Fisher精确检验对结果进行比较。
在367例连续的重度子痫前期患者中,106例(29%)患有HELLP综合征,261例(71%)患有重度子痫前期和子痫。未合并HELLP综合征的重度子痫前期患者与HELLP综合征患者分娩时的平均孕周和出生体重分别为34.1±6.1周 vs. 33.0±5.8周(p = 0.119)和1886±764 g vs. 1724±776 g(p = 0.063)。分别比较重度子痫前期-子痫和HELLP综合征的总体胎儿死亡率(4.6% vs. 10.3%,p = 0.009)和围产期死亡率(8.0% vs. 16.8%,p = 0.026),存在统计学显著差异。但当根据孕32周前后的孕周进行分析时,两组围产期死亡率的差异无统计学意义(p = 0.644和p = 0.250),提示差异临界。孕32周后胎儿死亡的最常见原因是胎盘早剥且未进行产前随访。重度子痫前期-子痫和HELLP综合征的新生儿发病率和新生儿死亡率分别为4.8% vs. 6.3%(p = 0.905),相似且差异无统计学意义。
与未合并HELLP的重度子痫前期相比,HELLP综合征根据孕32周前后孕周的围产期死亡率和新生儿发病率-死亡率相似,但未进行定期产前检查的HELLP综合征总体胎儿死亡率更高。