Abstract:

Abstract： Objective To analyze the current status and affecting factors of terminating pregnancy in severe preeclampsia without complications at admission . Methods Clinical observational data of 330 cases of severe preeclampsia (sPE) without serious complications at admission in Peking University Third Hospital, a tertiary teaching hospital, from Jan.2009 to Dec.2012 were analyzed. Cases were divided into groups according to the gestation-weeks (GW) at termination. Results A total of 330 cases of sPE without serious complications at admission accounted for about 83.3% of all cases of sPE diagnosed at discharge. There were 3/5 of cases with GW (<26-GW) considerations terminated pregnancy. Social factor was the independent influencing factor in the 26~＜28 GW group. Isolated massive proteinuria (>10g/24h)and serious complications occurrence were the main termination indications in the 28~＜30 GW group. The independent factors in sequence were social factor, maternal factors, fetal factors and placenta factors(P<0.05). In the 30~＜32GW group, the main termination indication was serious complications occurrence. The independent factors in sequence were maternal factors, massive proteinuria, placenta factors and fetal factors (P<0.05). In the 32~＜34GW group, the main termination indications were massive proteinuria, uncontrolled hypertension and abnormal fetal monitoring. The independent factors in sequence were maternal factors , fetal factors and placenta factors. In the 34~＜36GW group, GW（≥34-GW） consideration accounted for about 44.3%. The independent factors in sequence were GWconsideration, uncontrolled hypertension, abnormal S/D ratio and abnormal fetal monitoring (P<0.05). In the ≥36 GW group, about 68.3% cases terminated pregnancy under consideration of ≥36-GW. Conclusions This research shows that although there are various indicating factors affecting the termination of sPE pregnancy without serious complications，the fact of pure consideration of massive proteinuria and GW also exist. Whether it is appropriate to take the quantity of urine protein or GW alone as the indication of terminating pregnancy in isolated sPE will need further research and extensive clinical evidence.

Key words: severe preeclampsia, pregnancy termination；complications

摘要：

目的 分析无严重并发症重度子痫前期（severe preeclampsia，sPE）的终止妊娠影响因素和现状。方法   分析2009年1月至2012年12月北京大学第三医院单个教学医院4年间入院即诊断为重度子痫前期但不伴有严重并发症的330例临床观察资料的终止妊娠指征，按终止妊娠孕周分组。结果   330例入院诊断为sPE且不伴有严重并发症病例占同期出院诊断为sPE的83.3%。终止妊娠的指征在＜26周终止者以孕周为考虑因素者占3/5。26~＜28周组中社会因素是独立影响因素(P<0.001)。在28~＜30周组的主要影响因素有单纯尿蛋白因素（>10g/24h）、发生严重并发症 ；独立影响因素顺位为社会因素、母体因素、胎儿因素、胎盘因素 (P<0.05)。在30~＜32周组影响终止妊娠的主要因素为出现严重并发症；独立影响因素顺位为母体因素、单纯尿蛋白因素、胎盘因素、胎儿因素(P<0.05)。32~＜34周组影响终止妊娠的主要因素为尿蛋白因素、难以控制的高血压及胎心监护异常；独立影响因素顺位为母体因素以及尿蛋白因素、胎儿因素、胎盘因素。34~＜36周组以孕周为考虑因素占44.3%；独立影响因素顺位为孕周因素、难以控制的高血压、脐血流值异常、胎心监护异常(P<0.05)。≥36周后终止妊娠指征以孕周为考虑因素占68.3%。结论   影响入院时无严重并发症sPE终止妊娠的指征性因素较多，但存在着单纯以尿蛋白定量或单纯孕周因素为终止指征者。单纯以尿蛋白定量或单纯孕周因素为终止妊娠指征是否适宜有待更深入研究。

关键词: 重度子痫前期, 终止妊娠, 并发症