摘要：
目的 探讨中国大陆地区重度子痫前期孕妇的分娩方式及分娩时机.方法 选取中国大陆地区14个省份37家医院(包括20家三级医院及17家二级医院)2011年1月1日至12月31日诊断为重度子痫前期并住院分娩的2516例单胎孕产妇临床资料,根据不同的分娩方式分为剖宫产组和阴道分娩组,根据不同的分娩孕周分为Ⅰ组(≤27+6周),Ⅱ组(28 ～31+6周),Ⅲ组(32 ～ 33+6周),Ⅳ组(34 ～ 36+6周),Ⅴ组(≥37周).结果 (1)分娩方式:总体剖宫产率84.9％,阴道分娩率15.1％.不同分娩孕周(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ组间)的阴道分娩率及剖宫产率比较,差异有统计学意义(70.0％vs.30.0％、28.7％ vs.71.3％、11.1％ vs.88.9％、6.6％ vs.93.4％、14.7％ vs.84.9％,P＜0.05).(2)不同分娩方式及孕周对孕产妇的影响:不同分娩方式产后出血及孕产妇死亡率差异无统计学意义(5.3％ vs.5.6％、0.5％ vs.0.2％,P均＞0.05).不同分娩孕周(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ组间)的产后出血发生率差异无统计学意义(1.4％ vs.3.7％ vs.4.3％ vs.6.2％ vs.6.2％,P＞0.05),Ⅱ组、Ⅲ组、Ⅳ组、Ⅴ组中不同分娩方式的产后出血发生率差异无统计学意义(1.3％ vs.4.7％、3.2％ vs.4.4％、6.5％ vs.6.2％、7.9％ vs.5.8％,P均＞0.05).(3)不同分娩方式及孕周对新生儿的影响:剖宫产组围产儿死亡率明显低于阴道分娩组(3.8％ vs.36.8％,P＜O.05),而胎儿窘迫发生率及新生儿窒息率两组差异无统计学意义(6.8％ vs.9.5％、0.5％ vs.0.2％;P均＞0.05).各组中不同分娩方式的胎儿窘迫发生率差异无统计学意义(6.5％ vs.1 0.5％、9.7％ vs.16.1％、8.7％vs.8.9％、7.9％ vs.8.2％,P均＞0.05),Ⅱ及Ⅲ组中剖宫产组的新生儿窒息率明显高于阴道分娩组(48.7％vs.15.6％、27.0％ vs.6.5％,P均＜0.05),Ⅱ组、Ⅲ及Ⅳ组及Ⅴ组中剖宫产组的围产儿死亡率明显低于阴道分娩组(14.7％vs.75.3％、6.5％ vs.51.6％、2.3％ vs.28.3％、0.8％ vs.5.6％,P均＜0.05).结论 重度子痫前期孕妇大多以剖宫产终止妊娠,剖宫产不能降低孕产妇产后出血及孕产妇死亡的发生率,剖宫产组的围产儿死亡率较低.%Objective To analyze the mode and time of delivery of the pregnant women complicated with severe preeclampsia in China.Methods Totally 2516 singleton pregnant women who were diagnosed with severe preeclampsia in 37 hospitals (including 20 tertiary hospitals and 17 secondary hospital) in 14 provinces from January 1 to December 31 in 2011 were selected by a cross sectional survey.These cases were divided into two groups according to the mode of delivery (the cesarean section group and the vaginal delivery group),and into five groups according to the delivery weeks (group Ⅰ less than or equal to 27+6 weeks,group Ⅱ 28-31+6 weeks,group Ⅲ 32-33+6 weeks,group Ⅳ 34-36+6 weeks and group Ⅴ more than or equal to 37 weeks).Results (1) The mode of delivery:the cesarean section rate was 84.9％ while the vaginal delivery rate was 15.1％.The rates of vaginal delivery in different gestational weeks were different (70.0％ vs.30.0％,28.7％ vs.71.3％,11.1％ vs.88.9％,6.6％ vs.93.4％,14.7％ vs.84.9％,P＜0.05).(2)The effect of the delivery mode and time on the pregnant women:the rate of postpartum hemorrhage and maternal mortality was almost the same in the different delivery mode groups.(5.3％ vs.5.6％,0.5％ vs.0.2％,P ＞ 0.05).There was no significant difference in the rate of postpartum hemorrhage in different delivery weeks (1.4％ vs.3.7％ vs.4.3％ vs.6.2％ vs.6.2％,P ＞ 0.05).The rates of postpartum hemorrhage were almost the same between the different delivery groups in group Ⅱ,Ⅲ,Ⅳ and Ⅴ (1.3％ vs.4.7％,3.2％ vs.4.4％,6.5％ vs.6.2％,7.9％ vs.5.8％,P ＞ 0.05).(3)The effect of the delivery mode and time on the neonates:the perinatal mortality in the cesarean section group was significantly lower than that in the vaginal delivery group (3.8％ vs.36.8％,P ＜ 0.05).There were no significant differences in the rate of the fetal distress or neonatal asphyxia between the different delivery mode groups (6.8％ vs.9.5％,0.5％ vs.0.2％,P ＞ 0.05).The incidences of fetal distress were the same between the different delivery mode group in each gestation week group (6.5％ vs.10.5％,9.7％ vs.16.1％,8.7％ vs.8.9％,7.9％ vs.8.2％,P ＞ 0.05).The rate of neonatal asphyxia in the cesarean group Ⅱ and Ⅲ was significantly higher than vaginal delivery group (48.7％ vs.15.6％,27.0％ vs.6.5％,P ＜ 0.05).The perinatal mortality in cesarean group Ⅱ,Ⅲ,and Ⅴ was significantly lower than the vaginal delivery group (14.7％ vs.75.3％,6.5％ vs.51.6％,2.3％ vs.28.3％,0.8％ vs.5.6％,P ＜ 0.05).Conclusion Pregnant women complicated with severe preeclampsia mostly delivery by cesarean section.Cesarean section does not reduce maternal complications such as postpartum hemorrhage and maternal death,but the perinatal mortality is lower in the cesarean section group.
