子痫。七、子痫后的妊娠结局及长期预后。
Eclampsia. VII. Pregnancy outcome after eclampsia and long-term prognosis.
作者信息
Sibai B M, Sarinoglu C, Mercer B M
机构信息
Department of Obstetrics and Gynecology, University of Tennessee, Memphis.
出版信息
Am J Obstet Gynecol. 1992 Jun;166(6 Pt 1):1757-61; discussion 1761-3. doi: 10.1016/0002-9378(92)91566-s.
OBJECTIVES
Our goal was to report pregnancy outcome and long-term prognosis after eclampsia.
STUDY DESIGN
Women whose pregnancies were managed at the E.H. Crump Women's Hospital between August 1977 and April 1989 were studied. A total of 223 women with eclampsia underwent follow-up for an average of 7.2 years. Thirteen had preexisting hypertension and 210 were normotensive (31 were multiparous and 179 were nulliparous).
RESULTS
Among these women 23 who were multiparous and 159 who were nulliparous had 366 subsequent pregnancies: 22% of pregnancies were complicated by preeclampsia, 1.9% by eclampsia, and 2.5% by abruptio placentae; 2.7% resulted in perinatal death. Within the nulliparous group, women who had eclampsia before 37 weeks' gestation in the index pregnancy had significantly higher incidences of preeclampsia and poor perinatal outcome in subsequent pregnancies as compared with those who had eclampsia at greater than or equal to 37 weeks' gestation; the highest incidence of obstetric complications occurred in those having eclampsia at less than or equal to 30 weeks. Twenty of the 210 normotensive women (9.5%) had chronic hypertension on follow-up; the highest incidence (17.9%) being in those with eclampsia at less than or equal to 30 weeks and the lowest incidence (4.8%) in those having eclampsia at greater than or equal to 37 weeks. Women with eclampsia who had preeclampsia in subsequent pregnancies had a higher incidence of chronic hypertension as compared with those who were normotensive in subsequent pregnancies (25% vs 2%, p less than 0.0001). Long-term maternal complications included dialysis required in one patient and one case of cardiomyopathy in women with chronic hypertension; there was one maternal death in a women with chronic hypertension. None of the women had evidence of neurologic deficit or seizures during follow-up.
CONCLUSIONS
These findings should be used in counseling women who have had eclampsia and are considering future pregnancies.
目的
我们的目标是报告子痫后的妊娠结局和长期预后。
研究设计
对1977年8月至1989年4月在E.H.克伦普妇女医院接受孕期管理的妇女进行研究。共有223例子痫患者接受了平均7.2年的随访。其中13例孕前患有高血压，210例血压正常（31例经产妇，179例初产妇）。
结果
这些妇女中，23例经产妇和159例初产妇随后共有366次妊娠：22%的妊娠并发先兆子痫，1.9%并发子痫，2.5%并发胎盘早剥；2.7%导致围产期死亡。在初产妇组中，与子痫发生在孕37周及以后的妇女相比，指数妊娠子痫发生在孕37周之前的妇女随后妊娠并发先兆子痫的发生率和围产期不良结局的发生率显著更高；产科并发症发生率最高的是子痫发生在孕30周及以前的妇女。210例血压正常的妇女中有20例（9.5%）在随访时患有慢性高血压；子痫发生在孕30周及以前的妇女发生率最高（17.9%），子痫发生在孕37周及以后的妇女发生率最低（4.8%）。子痫患者随后妊娠并发先兆子痫的妇女慢性高血压发生率高于随后妊娠血压正常的妇女（25%对2%，P<0.0001）。长期的母体并发症包括1例患者需要透析，慢性高血压妇女中有1例发生心肌病；1例慢性高血压妇女死亡。随访期间，所有妇女均无神经功能缺损或癫痫发作的证据。
结论
这些研究结果应用于为有子痫病史且考虑未来妊娠的妇女提供咨询。
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