高血压妊娠中与不良围产期结局相关的参数。

Parameters associated with adverse perinatal outcome in hypertensive pregnancies.

作者信息

Shah D M, Reed G

机构信息

Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio 78284-7836, USA.

出版信息

J Hum Hypertens. 1996 Aug;10(8):511-5.

PMID:8895034

Abstract

BACKGROUND

Hypertensive disorders are a major contributor to perinatal morbidity and mortality. As all hypertensive pregnancies do not have a bad outcome, we sought to identify clinical and laboratory parameters associated with adverse perinatal outcome in hypertensive pregnancies.

METHODS

We analyzed the clinical course of 271 hypertensive patients delivered at a tertiary center. Adverse perinatal outcome included: (1) perinatal death; and (2) perinatal morbidity due to hypertension-related prematurity and uteroplacental vasculopathy. In our analysis, we sought to compare good and adverse perinatal outcome groups of hypertensive pregnancies. Two sample t-tests were used for continuous variables and chi 2-tests were performed for categoric variables. Blood pressures (BP) were analyzed by multivariate analysis for four time periods (P, I through IV) defined by gestational age in weeks: I, 10-19; II, 20-24; III, 25-29; and IV, 30-36.

RESULTS

There were 96 cases of adverse perinatal outcome due to hypertension (mortality, n = 6; morbidity, n = 90) in this series. Two clinical factors had a significant association with adverse perinatal outcome: (1) the need for prenatal treatment with antihypertensives (P < 0.0001); and (2) early onset of hypertension during the pregnancy (P < 0.008). The adverse outcome group had higher systolic (S) BP as early as 10-19 weeks (P < 0.01). This group had higher systolic and diastolic (D) BP as early as 20-24 weeks' gestation (P < 0.004-0.0001). Serum uric acid of > or = 6 mg/dl had a relative risk of 4.2 for adverse perinatal outcome (95% CI, 2.0-8.9; P < 0.0001).

CONCLUSIONS

Our study suggests that the increased severity and longer duration of hypertension may be the primary pathophysiologic mediator of adverse perinatal effects in these pregnancies. Elevated serum uric acid may be a clinically useful predictor of perinatal mortality and, more importantly, of perinatal morbidity in hypertensive pregnancies.

摘要

背景

高血压疾病是围产期发病和死亡的主要原因。由于并非所有高血压孕妇都会有不良结局，我们试图确定与高血压孕妇不良围产期结局相关的临床和实验室参数。

方法

我们分析了在一家三级中心分娩的271例高血压患者的临床过程。不良围产期结局包括：（1）围产期死亡；（2）因高血压相关早产和子宫胎盘血管病变导致的围产期发病。在我们的分析中，我们试图比较高血压孕妇的良好和不良围产期结局组。连续变量采用两样本t检验，分类变量采用卡方检验。根据孕周将血压（BP）分析为四个时间段（P、I至IV）：I，10 - 19周；II，20 - 24周；III，25 - 29周；IV，30 - 36周。

结果

本系列中有96例因高血压导致的不良围产期结局（死亡6例，发病90例）。两个临床因素与不良围产期结局显著相关：（1）需要产前使用降压药治疗（P < 0.0001）；（2）孕期高血压早发（P < 0.008）。不良结局组早在10 - 19周时收缩压（S）就较高（P < 0.01）。该组早在妊娠20 - 24周时收缩压和舒张压（D）就较高（P < 0.004 - 0.0001）。血清尿酸≥6mg/dl时，不良围产期结局的相对风险为4.2（95%可信区间，2.0 - 8.9；P < 0.0001）。