妊娠期糖尿病合并早发型重度子痫前期终止妊娠时机对母儿预后的临床分析

摘要

Objective To study the effect of the timing of termination of pregnancy on maternal and fetal outcomes of gestational diabetes mellitus ( GDM) combined with early onset severe preeclampsia. Methods 159 28 ～ 33 ＋6 weeks pregnant cases with GDM and early onset severe preeclampsia that collected from January 2005 ～ December 2009 in our hospital were retrospectively analyzed. According to onset gestational age, the cases were divided into 3 groups, group A (28 ～ 29 ＋6 weeks) , group B (30 ～31 ＋6 weeks) and group C (32 ～ 33 ＋6 weeks) . A proactive treatment ( A1B1C1 group, termination of pregnancy 24 to 48 hours after diagnosis) or expectant treatment (A282C2 group, termination of pregnancy ＞ 48 hours after diagnosis) , the timing of termination of pregnancy , maternal complications and perinatal outcomes were compared and analyzed among these groups. Results There was no significant difference in maternal morbidity or maternal mortality hetween proactive treatment groups and expectant treatment groups ( P ＞ 0. 05 ) . However, when the perinatal morbidity and perinatal mortality was compared, there was a significant difference between proactive treatment groups and expectant treatment groups (P ＜ 0. 05 ) . Conclusion In the treatment of pregnant woman with bothGDM and early onset severe preeclampsia, individualized treatment was recommended according to the gestation weeks. with complications or not, and conditions of fetus. For patients; For gestation weeks ＜ 34 weeks and without complications, expectant treatment could increase gestation weeks, newborn survival percentage and reduce perinatal morbidity and prenatal mortality. Termination of pregnancy in suitahle time could improve pregnancy outcomes.%目的 探讨妊娠期糖尿病(GDM)合并早发型重度子痫前期终止妊娠时机对母儿预后的影响.方法 对我院2005年1月～2009年12月间收治的159例孕28～33+6周的GDM合并重度子痫前期病例进行回顾性分析.按发病时孕周分为3组,A组(28～29+6周),B组(30～31+6周),C组(32～33+6周),观察比较各组中实施积极治疗(A1B1C1组,确诊后24～48h终止妊娠)和期待治疗(A282C2组,确诊后>48h终止妊娠)终止妊娠时机、孕产妇并发症发生情况及围产儿结局.结果 积极治疗和期待治疗各组孕产妇并发症发生率及死亡率比较差异无统计学意义(P>0.05);积极治疗和期待治疗各组围产儿病率及死亡率比较,差异有统计学意义(P<0.05).结论 GDM合并早发型重度子痫前期应根据发病孕周、孕妇有无并发症及胎儿宫内状况采取个体化治疗原则;对孕周<34周无并发症者进行期待治疗延长孕周,可提高新生儿存活率、降低围产儿病率及死亡率;适时终止妊娠,母婴有良好结局.