探讨重度子痫前期(severe preeclampsia, S-PE)并发胎盘早剥的相关因素、临床特征及母儿结局。

收集1992年3月至2009年3月在本院产科住院分娩的428例重度子痫前期产妇的临床资料，按是否并发胎盘早剥，将其分为观察组(n＝48)和对照组(n＝380)(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，得到该委员会审查、批准。分组征得受试对象的同意，并与其签订临床研究知情同意书)。采用回顾性研究方法对胎盘早剥的发病相关因素、临床特征及母儿结局进行统计学分析，并与对照组进行比较。

①1992年3月至2009年3月在本院分娩孕妇13 051例中，重度子痫前期发生率为3.28%(428/13 051)；重度子痫前期中，胎盘早剥的发生率为11.21%(48/428)。②两组产妇的平均年龄、体重指数(body mass index，BMI)及分娩孕周比较，差异无显著意义(P>0.05)。观察组产妇剖宫产率为87.5%(42/48)，对照组为73.15%(278/380)，两组比较，差异有显著意义(P<0.05)。③观察组产前最高舒张压、24 h尿蛋白量、血浆白蛋白、重度水肿率、眼底小动脉出血率、早孕期阴道出血率与对照组比较，差异有显著意义(P<0.05)。④两组胎盘附着于宫底宫角部位分别为36例及139例，两组比较，差异有显著意义(P<0.05)。⑤观察组产妇并发弥散性血管内凝血(disseminated intravascular coagulation，DIC)为11例，子宫切除为2例，围生儿死亡为12例，与对照组比较，差异有显著意义(P<0.05)。

重度子痫前期患者伴严重低蛋白、蛋白尿、水肿甚至腹水，胎盘位于宫底宫角处且早孕时伴不明原因阴道流血史者，应高度警惕发生胎盘早剥的可能性。

To study clinical characteristics, outcomes and correlated factors of severe preeclampsia(S-PE) complicating placenta abruption .

A retrospectively study of 428 cases of severe preeclampsia who delivered in the Department of Obstetrics, Second Hospital of Tianjin Medical University from March 1992 to March 2009 was conducted. They were divided into observation group (n=48) and control group (n=380) on account of whether complicated placenta abruption. Informed consent was obtained from all participates. The correlated factors, clinical characteristics and outcomes of placenta abruption between two groups were compared.

①The incidence of severe preeclampsia was 3.28%(48/428), and the incidence of placenta abruption among severe preeclampsia was 11.21%(48/428). ②General information and delivery: There were no significant differences regarding mean age, body mass index (BMI) and gestational weeks between two groups (P>0.05). The C-section rate in observation group (87.5%, 42/48)was higher than that of control group (73.15%, 278/380) (P<0.05). ③Correlated factors and clinical characteristics: There were significant differences in mean diastolic blood pressure, protein-uria in 24 h, low albumin-emia, abdominal water, retinal arteriola hemorrhage and bloody at first trimester between two groups (P<0.05). ④Placenta sites: The placenta at fundus or cornu of uterus were 36/48 vs. 139/380 (P<0.05). ⑤Other complications and outcomes: There were significant differences of disseminated intravascular coagulation (DIC, 11/48 vs. 2/380), hysterectomy (2/48 vs. 0/380), prenatal death (12/48 vs. 35/380) between two groups (P<0.05).

Severe preeclampsia complicating low albumin-emia, abdominal water, placenta site at fundus or cornu of uterus, retinal arteriola hemorrhage and bloody at first trimester maybe correlated with placenta abruption.