Kim Hye Yeon, Sohn Yong Seok, Lim Jae Hak, Kim Euy Hyuk, Kwon Ja Young, Park Yong Won, Kim Young Han
Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seodaemun-gu, Seoul 120-752, Korea.
Yonsei Med J. 2006 Jun 30;47(3):393-8. doi: 10.3349/ymj.2006.47.3.393.
The present study compares neonatal outcome after preterm delivery of infants in pregnancies complicated by the HELLP syndrome or severe preeclampsia (PS). The maternal and neonatal charts of 71 out of a total of 409 pregnancies that were complicated by hypertensive disorders at Severance hospital between January 1995 and December 2004 were reviewed. Twenty-one pregnancies were complicated by HELLP syndrome and 50 pregnancies were complicated by PS. Fifty normotensive (NT) patients who delivered because of preterm labor comprised the control group. Results were analyzed by the chi-square test and ANOVA. Gestational age and maternal age at delivery were matched among the three groups. The neonatal outcomes of the HELLP syndrome group were compared with the PS and NT groups. There were significant differences between the HELLP syndrome group and the PS group in the incidence of intraventricular hemorrhage (IVH) (61.9% vs. 26%, p=0.006), sepsis (85.7% vs. 44%, p =0.003) and mechanical ventilation (MV) rate (81% vs. 54%, p=0.039). There were significant differences between the HELLP syndrome group and the NT group in the incidence of neonatal death (ND) (19.5% vs. 2.0%, p=0.034), respiratory distress syndrome (RDS) (38.1% vs. 8%, p=0.0045), IVH (61.9% vs. 4%, p < 0.0001), sepsis (85.7% vs. 14%, p < 0.0001), intensive care (IC) (85.7% vs. 24%, p < 0.0001) and MV rate (80.1% vs. 14%, p < 0.0001). There were also significant differences between the PS and NT groups in the incidence of ND (20% vs. 2%, p=0.0192), RDS (30% vs. 8%, p=0.0085), IVH (26% vs. 4%, p=0.0070), sepsis (44% vs. 14%, p=0.0015), IC (78% vs. 24%, p < 0.0001), MV rate (54% vs. 14%, p < 0.0001) and low 5-min APGAR score (50% vs. 16%, p=0.0005). This study shows increased morbidity in newborns of mothers complicated with HELLP syndrome and indicates that early, regular and high quality management of these patients is essential to improve both maternal and neonatal outcome.
本研究比较了妊娠合并HELLP综合征或重度子痫前期（PS）的孕妇早产的新生儿结局。回顾了1995年1月至2004年12月在Severance医院共409例合并高血压疾病的妊娠中71例的母婴病历。21例妊娠合并HELLP综合征，50例妊娠合并PS。50例因早产分娩的血压正常（NT）患者组成对照组。结果采用卡方检验和方差分析进行分析。三组间的孕周和分娩时的产妇年龄相匹配。将HELLP综合征组的新生儿结局与PS组和NT组进行比较。HELLP综合征组与PS组在脑室内出血（IVH）发生率（61.9%对26%，p=0.006）、败血症（85.7%对44%，p =0.003）和机械通气（MV）率（81%对54%，p=0.039）方面存在显著差异。HELLP综合征组与NT组在新生儿死亡（ND）发生率（19.5%对2.0%，p=0.034）、呼吸窘迫综合征（RDS）（38.1%对8%，p=0.0045）、IVH（61.9%对4%，p<0.0001）、败血症（85.7%对14%，p<0.0001）、重症监护（IC）（85.7%对24%，p<0.0001）和MV率（80.1%对14%，p<0.0001）方面也存在显著差异。PS组与NT组在ND发生率（20%对2%，p=0.0192）、RDS（30%对8%，p=0.0085）、IVH（26%对4%，p=0.0070）、败血症（44%对14%，p=0.0015）、IC（78%对24%，p<0.0001）、MV率（54%对14%，p<0.0001）和5分钟阿氏评分低（50%对16%，p=0.0005）方面也存在显著差异。本研究表明，患有HELLP综合征的母亲所生新生儿的发病率增加，表明对这些患者进行早期、定期和高质量的管理对于改善母婴结局至关重要。
