Yang Zi, Wang Jia-lüe, Huang Ping, Shi Ling-yi, Li Rong, Ye Rong-hua, Chen Lei
Department of Obstetric and Gynaecology, Peking University Third Hospital, Beijing 100083, China.
Zhonghua Fu Chan Ke Za Zhi. 2006 May;41(5):302-6.
To explore the different clinical onset patterns in severe preeclampsia.
A prospective observational study was conducted in 173 cases of severe preeclampsia. They were divided into two groups according to the onset of gestational age of severe preeclampsia, early onset of severe preeclampsia (S-PE) (onset < or = 34 weeks) and late onset of S-PE (onset > 34 weeks). Then according to the onset pattern they were subdivided into 4 subgroups: early abrupt onset (10) and early onset with gradual progress of severe preeclampsia (87), late abrupt onset (18) and late onset with gradual progress of severe preeclampsia (58). Clinical characteristics in each subgroup were evaluated.
Cases with abrupt onset accounted for 16.2% out of 173 cases of severe preeclampsia (28/173). The incidence of abrupt onset or onset with gradual progress between early and late onset groups was not significantly different (P > 0.05). Whether in early onset group or late onset group, the incidence of serious maternal complications was much higher in abrupt onset subgroups than that in gradual progress subgroups [100.0% (10/10) vs 34.5% (30/87) and 100.0% (18/18) vs 29.3% (17/58); P < 0.001]. The incidence of serious maternal complications was not significantly different between early onset and late onset groups (P > 0.05). The perinatal mortality rate was higher in abrupt onset subgroups compared to gradual progress subgroups both in early onset groups and in late onset ones (72.7% vs 24.3%, P < 0.01; 22.2% vs 4.9%, P < 0.05). The perinatal mortality rate was higher in each subgroups in early onset groups than that in late onset ones respectively (P < 0.01, P < 0.05). The gestational age at delivery was closely associated with perinatal outcomes. When a delimitation of early onset of severe preeclampsia was set at 32-week gestation, perinatal outcome was associated with both gestational age at birth and the onset time of severe preeclampsia. If the cut-off point was set at 34-week gestation, perinatal outcome was associated only with gestational age at birth.
Approximately 16% pregnant women with severe preeclampsia were attacked abruptly and complicated by serious complications. The clinical delimitation of early onset of severe preeclampsia set at 32-week gestation is significantly associated with poor maternal and perinatal outcomes.
探讨重度子痫前期不同的临床发病模式。
对173例重度子痫前期患者进行前瞻性观察研究。根据重度子痫前期的发病孕周将其分为两组，即重度子痫前期早发型（S-PE）（发病孕周≤34周）和晚发型S-PE（发病孕周>34周）。然后根据发病模式将其细分为4个亚组：早发型急骤起病（10例）、早发型重度子痫前期渐进性起病（87例）、晚发型急骤起病（18例）和晚发型重度子痫前期渐进性起病（58例）。评估各亚组的临床特征。
173例重度子痫前期患者中急骤起病的病例占16.2%（28/173）。早发型组和晚发型组急骤起病或渐进性起病的发生率差异无统计学意义（P>0.05）。无论早发型组还是晚发型组，急骤起病亚组严重母体并发症的发生率均显著高于渐进性起病亚组[100.0%（10/10）对34.5%（30/87）以及100.0%（18/18）对29.3%（17/58）；P<0.001]。早发型组和晚发型组严重母体并发症的发生率差异无统计学意义（P>0.05）。早发型组和晚发型组急骤起病亚组的围产儿死亡率均高于渐进性起病亚组（72.7%对24.3%，P<0.01；22.2%对4.9%，P<0.05）。早发型组各亚组的围产儿死亡率均分别高于晚发型组（P<0.01，P<0.05）。分娩孕周与围产儿结局密切相关。当将重度子痫前期早发型的界定设定为妊娠32周时，围产儿结局与出生孕周及重度子痫前期的发病时间均相关。若将切点设定为妊娠34周，则围产儿结局仅与出生孕周相关。
约16%的重度子痫前期孕妇急骤起病并伴有严重并发症。将重度子痫前期早发型的临床界定设定为妊娠32周与不良的母体和围产儿结局显著相关。
