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School of Diagnosis|Maternal and Child Outcome Management of Severe Preeclampsia Patients onset 26 Weeks ago

School of Diagnosis|Maternal and Child Outcome Management of Severe Preeclampsia Patients onset 26 Weeks ago

(Summary description)

School of Diagnosis|Maternal and Child Outcome Management of Severe Preeclampsia Patients onset 26 Weeks ago

(Summary description)


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Hypertension in pregnancy is a group of diseases that coexist with pregnancy and increased blood pressure, which seriously affects the health of mothers and infants, and is the main reason for the increased mortality of pregnant women and perinatal infants. According to the domestic guidelines for the diagnosis and treatment of hypertension in pregnancy, patients with severe preeclampsia diagnosed before 26 weeks of pregnancy are recommended to terminate their pregnancy. However, in actual clinical work, the diagnosis and treatment of these patients, influencing factors, pregnancy outcome, management, etc. How is it?

Peking University People's Hospital collected 53 patients with severe preeclampsia (SPE) diagnosed in less than 26 weeks from 2007 to 2017, and explored the management of their pregnancy outcomes and influencing factors.


  Management of patients with severe preeclampsia before 26 weeks of pregnancy  


Patients with severe eclampsia are admitted to the hospital for treatment, including monitoring the mother and child, improving relevant testing, condition assessment, and giving symptomatic treatment such as rest, sedation, and antispasmodic treatment. According to the blood pressure, antihypertensive treatment is given.Antihypertensive drugs include labetalol hydrochloride, nifedipine, nicardipine hydrochloride, phentolamine, etc. For patients with liver and kidney function and other organ damages, medical assistance is required for medical assistance. Consider termination of pregnancy in the following situations:( 1) HELLP syndrome; (2) FGR or oligohydramnios; (3) fetal death in utero; (4) hypertensive encephalopathy; (5) cardiac insufficiency; (6) unsatisfactory blood pressure control; (7) renal function Insufficiency; (8) Pulmonary edema. After the termination of pregnancy, the patient's vital signs and laboratory indicators were monitored, and the patient was discharged after the condition stabilized. The management flowchart is as follows:



  Pregnancy outcome and newborn situation  


Of the 53 patients, 44 cases terminated their pregnancy due to severe complications, 8 cases of neonates with normal delivery, and 1 case was lost to follow-up.The total incidence of complications was 83.0%, of which 14 cases were FGR (26.4%), 10 cases (18.9%) of placental abruption, and 8 cases (15.1%) of HELLP syndrome (FGR and 1% occurred at the same time) 4 cases of HELLP syndrome), 7 cases of fetal death (13.2%) in utero, 4 cases of giving up treatment (0.7%), 3 cases of cardiac insufficiency (0.6%), and 2 cases of hypertensive encephalopathy (0 . 4% ). (See Table 1)


8 live babies were delivered: 1 case was aborted to 27+4 weeks of gestation. The pregnancy was terminated due to FGR. The patient requested active rescue of the newborn. The newborn died after 3 months of survival. One case developed FGR and HELLP syndromes after 28 weeks. The mother and child were monitored and delivered at 30 weeks after promoting fetal lung maturity. He was hospitalized in the neonatology department for nearly 2 months and was discharged. He was healthy and had no sequelae such as cerebral palsy. One case was hypoalbuminemia. He was given symptomatic treatment such as albumin and plasma infusion. The baby was preserved until 30 weeks after the birth of a live baby. He was discharged after 1 month in the neonatology department. He was in good health and had no sequelae such as cerebral palsy. One case was a delivery case in 2017. He was discharged from the neonatology department for nearly 2 months after being hospitalized. No obvious abnormality is seen. Further follow-up is needed. Two cases of newborn deaths, one case of placental abruption, severe neonatal asphyxia, and family members gave up treatment.


  Discussion of Severe Preeclampsia Cases  


The number of severe preeclampsia diagnosed in the second trimester of pregnancy has been increasing in the past ten years. The current consensus is that,Treatment can be expected for patients with early-onset severe preeclampsia without obvious organ damage. Some studies believe that the perinatal outcome of patients with severe preeclampsia in the second trimester depends on the gestational week of the expected start of treatment and the gestational week of the termination of pregnancy. For those less than 24 weeks Patients with severe preeclampsia or patients with severe FGR less than 26 weeks are not recommended to expect treatment. Close monitoring of mothers and children in medical centers with conditions can well improve the perinatal outcome of patients with severe preeclampsia after 24 weeks.



The selected cases in this study were patients with severe preeclampsia less than 26 weeks old. A retrospective analysis of the management, prognosis and repregnancy outcomes of these patients showed that patients less than 26 weeks old had severe preeclampsia in critical condition, with more complicated conditions. Severe complications, the final choice of pregnancy termination, the reason for the onset of early gestation and critical illness is related to the following factors:(1) More than 50% of the medical records studied were chronic hypertension complicated with preeclampsia. This part of the patients did not have a good blood pressure control and pre-pregnancy assessment before pregnancy, that is, pregnancy, so that the onset is early and the condition is critical. (2) Irregular checkups during pregnancy, failure to detect changes in the condition in time, and failure to intervene in time. (3) It is found that the patient has not followed the doctor’s advice for hospitalization, but the condition is further aggravated and serious complications occur, and the pregnancy is terminated.。


  With the opening of my country’s second-child policy, the increase in elderly patients, the application of assisted reproductive technology, and the increasing number of high-risk patients, it is a new challenge to the hospital’s diagnosis and treatment level and physician skills. Therefore, for patients with high risk factors for preeclampsia Pre-pregnancy assessment, prevention, and management during pregnancy are more important。


  Maternal and Child Health Aucheer in action  


Ningbo Aocheng focuses on providing reliable, fast and convenient in vitro diagnostic reagents for clinics from early detection, diagnosis, prevention and detection of diseases,Committed to providing professional maternal and child health clinical diagnosis solutions, with Aucheer PlGF detection reagents, it will usher in a new era of preeclampsia risk assessment and management.


Original Source

Liu Dongling, Xu Qi, Wang Yan, Wei Jun, Liu Guoli. Maternal and child outcomes and repregnancy management in patients with severe preeclampsia onset 26 weeks ago[J], Chinese Journal of Reproductive Health ,2019,30(5):411-414


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