Abstract
目的
妊娠期高血压疾病是一类严重危害孕产妇及胎儿健康的疾病，且发病率高。本研究旨在分析妊娠期高血压疾病孕产妇的患病情况及发生危重情况的影响因素，为制订干预措施提供依据。
方法
采用横断面研究，收集2012年1月1日至2019年12月31日湖南省所有妇幼保健院住院分娩的孕产妇100 683例，共监测到妊娠期高血压疾病孕产妇6 579例。应用SAS9.4统计分析孕产妇基本情况、临床资料、产妇结局，并分析影响妊娠期高血压疾病孕产妇发生危重情况的危险因素。
结果
妊娠期高血压疾病患病率由2012年的4.3%上升到2019年的7.1%，妊娠期高血压疾病合并症人数占妊娠高血压疾病人数的比例由2012年的28.1%上升到2019年的83.7%。高龄孕产妇占22.2%，已婚孕产妇占99.9%，大学及以上学历占49.5%，妊娠1次的占38%，产次为0的占63.5%，既往剖宫产次数为1及以上的占18.4%，约99.0%的孕产妇产前检查的次数为5~10，有合并症的占72.6%，出院时终止妊娠的占93.8%。前3位合并症分别是贫血(2 355例，29.3%)，妊娠期糖尿病(1 886例，23.4%)，亚临床甲状腺功能减退(947例，11.8%)。Logistic回归分析显示子宫破裂、胎盘早剥、前置胎盘、贫血和心脏病是危重孕产妇的独立危险因素。
结论
孕产妇妊娠期高血压疾病患病率呈上升趋势，应加强对甲状腺功能减退、妊娠期糖尿病、贫血等并发症的孕检，对子宫破裂、胎盘早剥、前置胎盘、贫血和心脏病应积极采取防治措施。
Keywords: 妊娠期高血压疾病, 合并症, 危重孕产妇
Abstract
Objective
Hypertensive disorders complicating pregnancy is a kind of disease that seriously endangers the health of pregnant women and fetuses with high incidence. This study aims to analyze the prevalence of pregnant women with hypertensive disorders complicating pregnancy and the influential factors for critical pregnant women, and to provide basis for intervention measures.
Methods
In an institution-based cross-sectional study, 100 683 pregnant women, who gave birth in all maternal and child health hospitals of Hunan Province from January 1, 2012 to December 31, 2019, were collected, and 6 579 pregnant women with hypertensive disorders complicating pregnancy were monitored. All data were analyzed through SAS9.4 software. The basic situation, clinical data, outcome, and complications of pregnant women were analyzed, and the risk factors for critical pregnant women with hypertensive disorders complicating pregnancy were analyzed.
Results
The prevalence rate of hypertensive disorder complicating pregnancy was increased from 4.3% in 2012 to 7.1% in 2019, and the proportion of hypertensive disorder complicating pregnant women with complications in the hypertensive disorder complicating pregnant women was increased from 28.1% in 2012 to 83.7% in 2019. Elderly pregnant women accounted for 22.2%, married women accounted for 99.9%, women with university degree accounted for 49.5%, one pregnancy accounted for 38%, and zero delivery accounted for 63.5%. In the past, 18.4% of pregnant women had more than one cesarean section, accounting for 18.4%. About 99.0% of pregnant women had 5-10 antenatal check-ups, 72.6% had complications, and 93.8% were terminated when they were discharged. The first 3 complications were anemia in 2 355 cases (29.3%), gestational diabetes in 1 886 cases (23.4%), and subclinical hypothyroidism in 947 cases (11.8%). Logistic regression analysis showed that uterine rupture, placental abruption, placenta previa, anemia, and heart disease were independent risk factors for critical pregnant women.
Conclusion
The prevalence of hypertensive disorders complicating pregnancy is on the rise. Pregnancy examination should be enhanced to identify the complications such as hypothyroidism, gestational diabetes, and anemia. Prevention and treatment measures should be actively taken for uterine rupture, placental abruption, placenta previa, anemia, and heart disease.
Keywords: hypertensive disorders complicating pregnancy, complications, critical pregnant women
妊娠期高血压疾病(hypertensive disorders complicating pregnancy，HDCP)包括妊娠期高血压、先兆子痫、子痫、慢性高血压并发先兆子痫及妊娠合并慢性高血压[1]。妊娠期高血压疾病是一个世界性的健康问题，其并发症发生率高达10%[2]，并与产妇、新生儿和胎儿发病率和死亡率升高有关。虽然发达国家的孕产妇死亡率显著低于发展中国家，但死亡孕产妇中死于妊娠期高血压疾病的概率为16%[3]。妊娠期高血压疾病在我国发病率为9.4%~10.4%[4]。其发病原因目前不是十分清楚，并发症可累及全身的重要器官，如心、脑、血管[5-6]。患妊娠期高血压疾病的孕产妇主要死于胎盘早剥、心血管疾病、产后大出血、弥漫性血管内凝血(disseminated intravascular coagulation，DIC)等严重的并发症[7-8]。妊娠期高血压疾病也会导致胎儿宫内生长受限、早产、死胎及死产等[9-11]。
为了解妊娠期高血压疾病孕产妇的患病现状及其相关因素，提高产科诊治能力，本研究收集湖南省内所有妇幼保健院2012―2019年妊娠期高血压疾病住院患者的基本情况、分娩情况及合并症等资料，以期分析妊娠期高血压疾病孕产妇的患病情况及其影响因素，为制订干预措施提供依据。
1. 对象与方法
1.1. 对象
收集2012年1月1日至2019年12月31日在湖南省内所有妇幼保健院(共137家)产科有出院记录的孕产妇为研究对象，包括因病入院和待产入院的孕产妇。排除在其他科室住院的孕产妇以及单纯因保胎入院的孕产妇，如体外受精术后、中医保胎、患者要求或仅有轻微腹痛但不伴有其他产科合并症及并发症收住院的孕产妇。
1.2. 方法
每院指定1名医师负责收集该院产科所有入院孕产妇相关数据(病例资料由管床医师填写)。孕产妇入院之日即进入被监测状态，由数据收集者逐一收集《孕产妇个案调查表》中的相关信息。同时需要每天访视产科病房、产房或相关科室、重症监护室，随时观察孕产妇病情的动态变化，查阅病历；记录调查表中要求的重要信息，在孕产妇出院之前完成调查表中有关内容的填写。《孕产妇个案调查表》内容包括：孕产妇的个人信息、妊娠终止情况、合并症或者并发症、抢救措施和过程、孕产妇与围产儿结局。危重孕产妇的定义是患有危及生命的产科合并症或并发症，但由于接受了良好的医疗服务或偶然的机会存活下来的孕产妇[12]。
1.3. 质量控制
区级妇幼保健机构每月对收集的调查表的完整性、准确性、逻辑关系等进行审核，每6个月进行一次质量检查；市级妇幼保健院于每年11月10日前，省级于每年12月10日前完成一次质量检查；各级质量检查完成后填写《全国危重孕产妇医院监测质量调查表》，并逐级上报。
1.4. 统计学处理
利用SAS 9.4统计软件对数据进行处理，定量资料采用均数±标准差( ±s)表示，统计推断采用t检验；定性资料采用率或者构成比表示，统计推断采用χ 2检验。采用多因素非条件logistic回归模型分析妊娠期高血压疾病的影响因素，P<0.05为差异有统计学意义。
2. 结 果
2.1. 孕产妇妊娠期高血压疾病患病情况
共监测孕产妇100 683例，其中妊娠期高血压疾病6 579例。妊娠期高血压疾病患病率由2012年的4.3%上升到2019年的7.1%。妊娠期高血压疾病合并症人数占妊娠高血压疾病人数的比例由2012年的28.1%上升到2019年的83.7%(表1)。
表1.
2012至2019年孕产妇妊娠期高血压疾病的患病情况
Table 1 Prevalence of hypertensive disorders complicating pregnancy of pregnant women from 2012 to 2019
| 年份 | 监测孕产妇数 | 妊娠期高血压疾病人数 | 妊娠期高血压疾病患病率/% | 妊娠期高血压疾病合并症人数 | 妊娠期高血压疾病合并症发生率/% |
|---|---|---|---|---|---|
| 合计 | 100 683 | 6 579 | 6.5 | 4 779 | 72.6 |
| 2012 | 9 286 | 399 | 4.3 | 112 | 28.1 |
| 2013 | 9 628 | 722 | 7.5 | 339 | 47.0 |
| 2014 | 11 840 | 748 | 6.3 | 531 | 71.0 |
| 2015 | 12 734 | 808 | 6.3 | 605 | 74.9 |
| 2016 | 10 726 | 639 | 6.0 | 529 | 82.8 |
| 2017 | 14 174 | 968 | 6.8 | 768 | 79.3 |
| 2018 | 15 075 | 1 071 | 7.1 | 871 | 81.3 |
| 2019 | 17 220 | 1 224 | 7.1 | 1 024 | 83.7 |
2.2. 妊娠期高血压疾病孕产妇基本情况
高龄孕产妇(≥35岁)占22.2%，已婚孕产妇占99.9%，大学及以上学历占49.5%，妊娠1次的占38%，产次为0的占63.5%，既往剖宫产次数为1及以上的占18.4%，产前检查5~10次的孕产妇占99.0%，有与妊娠、分娩、产褥与流产相关的合并症或并发症的占72.6%，出院时终止妊娠的占93.8%(表2)。所有妊娠期高血压疾病孕产妇出院时生命状态均为存活。
表2.
妊娠期高血压疾病孕产妇基本情况
Table 2 Basic situation of pregnant women with hypertensive disorders complicating pregnancy
| 指标 | 数量 | 构成比/% | 指标 | 数量 | 构成比/% |
|---|---|---|---|---|---|
| 年龄/岁 | 产次(不包括此次分娩) | ||||
| ≤19 | 14 | 0.2 | 0 | 4 178 | 63.5 |
| 20~24 | 435 | 6.6 | 1 | 2 203 | 33.5 |
| 25~29 | 2 387 | 36.3 | 2 | 186 | 2.8 |
| 30~34 | 2 258 | 34.3 | 3及以上 | 12 | 0.2 |
| ≥35 | 1 458 | 22.2 | 产前检查次数(不包括此次住院检查) | ||
| 婚姻状况 | 0 | 2 | 0.0 | ||
| 单身/离异/丧偶/其他 | 4 | 0.1 | 1~<5 | 51 | 0.8 |
| 已婚 | 6 575 | 99.9 | 5~10 | 6 515 | 99.0 |
| 受教育程度 | 10以上 | 8 | 0.1 | ||
| 大学或以上含大专 | 3 254 | 49.4 | 既往剖宫产次数 | ||
| 高中、中专 | 3 276 | 49.8 | 0 | 5 372 | 81.6 |
| 初中 | 45 | 0.7 | 1 | 1 123 | 17.1 |
| 小学及以下 | 4 | 0.1 | 2 | 83 | 1.3 |
| 妊娠次数(包括此次分娩) |
本次有无与妊娠、分娩、产褥期、 流产相关的合并症或并发症 |
||||
| 1 | 2 500 | 38.0 | |||
| 2 | 1 805 | 27.4 | 是 | 4 779 | 72.6 |
| 3 | 1 133 | 17.2 | 否 | 1 800 | 27.4 |
| 4及以上 | 1 141 | 17.4 | 终止妊娠 | ||
| 孕妇出院时孕产妇生命状态 | 是 | 6 168 | 93.8 | ||
| 存活 | 6 579 | 100.0 | 否 | 411 | 6.2 |
| 死亡 | 0 | 0.0 |
年龄数据缺失27例，产检数据缺失3例，既往剖宫产数据缺失1例。
2.3. 妊娠期高血压疾病孕产妇合并症情况
妊娠期高血压疾病孕产妇合并症前3位是贫血(2 355例，29.3%)、妊娠期糖尿病(1 886例，23.4%)、亚临床甲状腺功能减退(947例，11.8%)，详见表3。
表3.
妊娠期高血压疾病孕产妇合并症情况
Table 3 Maternal complications of pregnant women with hypertensive disorders complicating pregnancy
| 合并症/并发症 | 人数 | 占比/% |
|---|---|---|
| 贫血 | 2 355 | 29.3 |
| 妊娠期糖尿病 | 1 886 | 23.4 |
| 亚临床甲状腺功能减退 | 947 | 11.8 |
| 胎膜早破 | 861 | 10.7 |
| 胎盘粘连 | 609 | 7.6 |
| 子宫肌瘤 | 357 | 4.4 |
| 羊水过少 | 297 | 3.7 |
| 宫缩乏力 | 270 | 3.4 |
| 前置胎盘 | 195 | 2.4 |
| 胎盘早剥 | 102 | 1.3 |
| 上呼吸道感染 | 63 | 0.8 |
| 其他系统感染/脓毒血症 | 62 | 0.7 |
| 肾病 | 33 | 0.4 |
| 心脏病 | 9 | 0.1 |
2.4. 妊娠期高血压疾病孕产妇发生危重情况的影响 因素
单因素分析显示：患妊娠期高血压疾病的孕产妇合并子宫破裂、胎盘早剥、前置胎盘、心脏病、贫血是发生危重情况的影响因素(均P<0.05，表4)。
表4.
妊娠期高血压疾病的孕产妇发生危重情况的单因素分析结果
Table 4 Results of a univariate analysis on the occurrence of critically ill in pregnant women with hypertensive disorders complicating pregnancy
| 因素 | 是否危重/例 | χ2 /Z | P | ||
|---|---|---|---|---|---|
| 是 | 否 | ||||
| 子宫破裂* | 是 | 1 | 2 | 0.034 | |
| 否 | 75 | 6 501 | |||
| 胎盘早剥 | 是 | 14 | 88 | 143.374 | <0.001 |
| 否 | 62 | 6 415 | |||
| 前置胎盘 | 是 | 10 | 185 | 27.776 | <0.001 |
| 否 | 66 | 6 315 | |||
| 心脏病* | 是 | 2 | 7 | 0.004 | |
| 否 | 74 | 6 496 | |||
| 贫血 | 是 | 58 | 2 297 | 54.894 | <0.001 |
| 否 | 18 | 4 203 | |||
| 妊娠期糖尿病 | 是 | 18 | 1 868 | 0.934 | 0.334 |
| 否 | 58 | 4 635 | |||
| 肾病* | 是 | 1 | 32 | 0.319 | |
| 否 | 75 | 6 471 | |||
| 肺病* | 是 | 0 | 3 | 1.000 | |
| 否 | 76 | 6 500 | |||
| 妊娠次数† | 2(1~4) | 2(1~3) | -1.894 | 0.058 | |
| 产次† | 0(0~1) | 0(0~1) | -1.590 | 0.112 | |
| 产前检查次数† | 9(9~10) | 9(9~10) | -0.339 | 0.735 | |
| 既往剖宫产次数† | 0(0~0) | 0(0~0) | -0.943 | 0.345 | |
| 年龄† | 30(27~35) | 30(28~34) | -0.590 | 0.555 | |
*采用Fisher确切概率法；†连续数值型变量。前置胎盘和贫血数据缺失2例，错误填写1例，实际例数为6 576。
将单因素分析结果中差异有统计学意义的指标纳入多因素分析，以是否危重为因变量(危重=1，不是危重=0)，子宫破裂、胎盘早剥、前置胎盘、贫血和心脏病为自变量，进行多因素logistic回归分析。结果显示：子宫破裂、胎盘早剥、前置胎盘、贫血和心脏病都是妊娠期高血压疾病发生危重情况的独立危险因素(均P<0.05，表5)。
表5.
妊娠期高血压疾病孕产妇发生危重情况的多因素分析结果
Table 5 Results of multi-factor analysis on the occurrence of critically ill in pregnant women with hypertensive disorders complicating pregnancy
| 变量 | b | SE | Wald χ2 | P | OR | 95% CI |
|---|---|---|---|---|---|---|
| 子宫破裂 | 4.180 | 1.452 | 8.288 | 0.004 | 65.373 | 3.797~1 125.462 |
| 胎盘早剥 | 2.565 | 0.330 | 60.406 | <0.001 | 12.994 | 6.806~24.810 |
| 前置胎盘 | 1.410 | 0.363 | 15.069 | <0.001 | 4.096 | 2.010~8.346 |
| 贫血 | 1.466 | 0.278 | 27.758 | <0.001 | 4.330 | 2.510~7.470 |
| 心脏病 | 0.787 | 0.261 | 8.884 | 0.003 | 2.198 | 1.309~3.688 |
| 常量 | -6.039 | 0.294 | 420.630 | <0.001 | 0.002 |
基于以上结果，选择子宫破裂、胎盘早剥、前置胎盘、贫血和心脏病这5个因素对妊娠期高血压疾病孕产妇危重情况进行预测，预测的准确率为98.8%，提示以上结果具有较好的应用价值。
3. 讨 论
本研究发现：妊娠期高血压疾病患病率呈上升趋势，同时妊娠期高血压疾病孕产妇并发症发生率逐年升高。这可能与基层医院妊娠期高血压疾病孕产妇转入有关。转入的孕产妇大多数为外来务工人员或农民，其学历和经济收入水平较低，保健意识薄弱，不重视围产期的保健，未按期进行产前检查，不能及时发现和防治妊娠期高血压疾病，病情由轻症发展成重症。妊娠期高血压疾病患病率升高也可能与近年产前检查次数增加，对妊娠期高血压疾病的早期诊断率升高相关。妊娠期高血压疾病患病率及合并症占比有升高趋势，但孕产妇死亡率一直为零，提示妊娠期高血压疾病孕产妇的诊断、治疗及管理处于较好水平。在本研究中，孕产妇妊娠期高血压疾病的患病率为6.5%，低于中国10个中心研究[13]结果显示的18.4%的妊娠期高血压疾病患病率，但高于武汉市4.0%的妊娠期高血压疾病患病率[14]，也高于石家庄市6.1%的妊娠期高血压疾病患病率[15]。
早期诊断是预防和有效治疗妊娠期高血压疾病的关键，孕妇应该定期接受孕期检查，及时发现危险因素并有效纠正。本研究显示99%的孕产妇产前检查次数均在5以上，说明孕产妇的保健意识在不断提高，但针对妊娠期高血压、贫血、糖尿病等是否进行了有效干预，以及干预的效果，还有待进一步研究。在患妊娠期高血压疾病的孕产妇中，4 779例(72.6%)有与妊娠、分娩、产褥期、流产相关的合并症，明显高于2015年全国监测地区住院分娩孕产妇妊娠合并症的发生率(47.46%)[16]。妊娠期贫血、妊娠糖尿病对母儿均可造成不良影响，尤其对新生儿远期造成不良影响[17-18]。我国孕产妇妊娠晚期贫血的发病率较高[19]，在妊娠早、中、晚期患病率分别为9.6%、19.8%和33.8%。妊娠糖尿病的全球多中心研究[20]表明妊娠糖尿病患病率高达17.8%。妊娠合并亚临床甲状腺功能减退的发病率为2.2%~5.6%[21]。研究[22-23]显示：妊娠合并亚临床甲状腺功能减退者妊娠期高血压疾病发生率增高，且给予优甲乐治疗能明显降低妊娠期高血压疾病和妊娠期糖尿病的发生率。这提示我们需积极控制妊娠合并症，以减少母婴不良妊娠结局的发生。
本研究单因素分析结果示患妊娠期高血压疾病的孕产妇合并子宫破裂、胎盘早剥、前置胎盘、心脏病、贫血与发生危重情况相关，logistic多因素分析发现子宫破裂、胎盘早剥、前置胎盘、贫血和心脏病是妊娠高血压疾病孕产妇发生危重情况的独立危险因素。子宫收缩乏力、胎盘因素、异位妊娠和子宫破裂仍然是产科致死性出血的重要原因，胎盘因素导致难治性产后出血孕产妇死亡的比例呈逐年上升趋势[24]。在无剖宫产史的患者中，多胎妊娠、慢性高血压和绒毛膜羊膜炎是子宫破裂的高风险因素，这些因素加在一起使子宫破裂的风险增加59倍[25]。妊娠期高血压疾病患者的病理特点主要为动脉痉挛、子宫小血管痉挛，导致子宫蜕膜与子宫肌层血管发生动脉粥样硬化，毛细血管缺血坏死而破裂出血。血液会流到蜕膜底层，引起胎盘后血肿；一旦出现胎盘后血肿，就会引起胎盘与子宫壁分离，造成胎盘从子宫壁剥离，引起胎盘早剥[26]。本研究显示前置胎盘是发生危重情况的危险因素，与文献[27]的结果一致。2项病例对照研究[28-29]发现前置胎盘与先兆子痫之间呈明显的负相关关系。下一步有必要进一步研究二者的关系。血压与心血管事件(卒中、心肌梗死、猝死、心力衰竭和外周动脉病)及终末期肾病的发生率呈独立正相关，血压升高和其他心血管危险因素相互促进[30]。分析危重孕产妇疾病发生、发展过程，相比于单独分析孕产妇死因，更有利于医疗干预措施的制订和实施[31]。
本研究属于横断面研究，得到的危险因素需要病例对照或者前瞻性研究加以印证；研究过程未收集孕妇内分泌疾病等的病史，结果分析可能存在混杂和一定的局限性。下一步将分析妊娠期高血压疾病的分娩结果及影响因素，为卫生行政部门决策提供数据支持。
基金资助
国家自然科学基金(81973137)；湖南省科技厅项目(2018SK2062)。
This work was supported by the National Natural Science Foundation (81803313) and Program from Hunan Provincial Science and Technology Department (2018SK2062), China.
利益冲突声明
作者声称无任何利益冲突。
原文网址
http://xbyxb.csu.edu.cn/xbwk/fileup/PDF/202108814.pdf
参考文献
- 1. 谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018: 83. [Google Scholar]; XIE Xing, KONG Beihua, DUAN Tao. Obstetrics and gynecology[M]. 9th ed. Beijing: People’s Medical Publishing House, 2018: 83. [Google Scholar]
- 2. Antza C, Cifkova R, Kotsis V. Hypertensive complications of pregnancy: a clinical overview[J]. Metabolism, 2018, 86: 102-111. [DOI] [PubMed] [Google Scholar]
- 3. Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: a systematic review[J]. Lancet, 2006, 367(9516): 1066-1074. [DOI] [PubMed] [Google Scholar]
- 4. 王贝贝. 20年间妊娠期高血压疾病发病情况及相关影响因素分析[D]. 北京: 首都医科大学, 2015. [Google Scholar]; WANG Beibei. Secular trends of gestational hypertension disease throughout 20 years: prevalence, risk factors[D]. Beijing: Capital Medical University, 2015. [Google Scholar]
- 5. Shopen N, Schiff E, Koren-Morag N, et al. Factors that predict the development of hypertension in women with pregnancy-induced hypertension[J]. Am J Hypertens, 2016, 29(1): 141-146. [DOI] [PubMed] [Google Scholar]
- 6. Veerbeek JH, Hermes W, Breimer AY, et al. Cardiovascular disease risk factors after early-onset preeclampsia, late-onset preeclampsia, and pregnancy-induced hypertension[J]. Hypertension, 2015, 65(3): 600-606. [DOI] [PubMed] [Google Scholar]
- 7. Mehare T, Kebede D. Fetoplacental weight relationship in normal pregnancy and pregnancy complicated by pregnancy-induced hypertension and abruption of placenta among mothers who gave birth in southern Ethiopia, 2018[J]. Obstet Gynecol Int, 2020, 2020: 6839416. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. 《中国高血压防治指南》修订委员会 . 中国高血压防治指南2018年修订版[J]. 心脑血管病防治, 2019, 19(1): 1-44. [Google Scholar]; Committee for Revising the Guidelines for the Prevention and treatment of Hypertension in China . Guidelines for the prevention and treatment of hypertension in China (revised in 2018)[J]. Prevention and Treatment of Cardio-Cerebral-Vascular Disease, 2019, 19(1): 1-44. [Google Scholar]
- 9. Bakker R, Steegers EA, Hofman A, et al. Blood pressure in different gestational trimesters, fetal growth, and the risk of adverse birth outcomes: the generation R study[J]. Am J Epidemiol, 2011, 174(7): 797-806. [DOI] [PubMed] [Google Scholar]
- 10. Yücesoy G, Ozkan S, Bodur H, et al. Maternal and perinatal outcome in pregnancies complicated with hypertensive disorder of pregnancy: a seven year experience of a tertiary care center[J]. Arch Gynecol Obstet, 2005, 273(1): 43-49. [DOI] [PubMed] [Google Scholar]
- 11. Chen SN, Wang PH, Hsieh MF, et al. Maternal pregnancy-induced hypertension increases the subsequent risk of neonatal candidiasis: a nationwide population-based cohort study[J]. Taiwan J Obstet Gynecol, 2019, 58(2): 261-265. [DOI] [PubMed] [Google Scholar]
- 12. Pattinson R, Say L, Souza JP, et al. WHO maternal death and near-miss classifications[J]. Bull World Health Organ, 2009, 87(10): 734. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Lu CQ, Lin J, Yuan L, et al. Pregnancy induced hypertension and outcomes in early and moderate preterm infants[J]. Pregnancy Hypertens, 2018, 14: 68-71. [DOI] [PubMed] [Google Scholar]
- 14. 周爱芬, 赵瑾珠, 章一鸣, 等. 武汉市妊娠期高血压疾病及其不良妊娠结局大样本流行病学分析[J]. 中国妇幼保健, 2013, 28(18): 2957-2960. [Google Scholar]; ZHOU Aifen, ZHAO Jinzhu, ZHANG Yiming, et al. Large sample epidemiological analysis of pregnancy-induced hypertension and bad pregnancy outcome in Wuhan[J]. Maternal and Child Health Care of China, 2013, 28(18): 2957-2960. [Google Scholar]
- 15. 刁英飞, 刘展, 冯冬颖, 等. 石家庄市4 431例孕产妇妊娠并发症发病率及因素分析[J]. 现代预防医学, 2016, 43(16): 2938-2941. [Google Scholar]; DIAO Yingfei, LIU Zhan, FENG Dongying, et al. The morbidity and risk factors of 4 431 pregnant and puerperal women’s pregnancy complications in Shijiazhuang[J]. Modern Preventive Medicine, 2016, 43(16): 2938-2941. [Google Scholar]
- 16. 全国妇幼卫生监测办公室 . 2015年全国危重孕产妇医院监测主要结果报告[R]. 北京: 国家卫生和计划生育委员会, 2016: 121-131. [Google Scholar]; National Maternal and Child Health Monitoring Office . Report on the main results of 2015 National Critical Maternal Hospital surveillance[R]. Beijing: National Health and Family Planning Commission, 2016: 121-131. [Google Scholar]
- 17. World Health Organization . World wide prevalence of anemia 1993. ―2005. WHO global database on anemia[M]. Geneva: World Health Organization, 2008. [Google Scholar]
- 18. Gupta Y, Kalra B, Baruah MP, et al. Updated guidelines on screening for gestational diabetes[J]. Int J Women's Heal, 2015, 7: 539-550. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. 翟云燕. 610例孕妇妊娠晚期贫血状况的调查及妊娠晚期不同补铁方式的效果对比[D]. 石家庄: 河北医科大学, 2016. [Google Scholar]; ZHAI Yunyan. Investigation on the status of prenatal anemia and prognosis of iron deficiency anemia in late pregnancy due to ferrous supplement method[D]. Shijiazhuang: Hebei Medical University, 2016. [Google Scholar]
- 20. Sacks DA, Hadden DR, Maresh M, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study[J]. Diabetes Care, 2012, 35(3): 526-528. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21. 陈荣辉, 肖祎, 程翠萍, 等. 妊娠期妇女甲状腺功能减退患病率与妊娠不良结局的临床分析[J]. 中国妇幼保健, 2010, 25(12): 1614-1615. [Google Scholar]; CHEN Ronghui, XIAO Yi, CHENG Cuiping, et al. Clinical analysis of the prevalence of hypothyroidism and adverse pregnancy outcome in pregnant women [J]. Maternal and Child Health Care of China, 2010, 25(12): 1614-1615. [Google Scholar]
- 22. 张玲, 徐晓英, 忽平, 等. 妊娠合并亚临床甲减孕妇孕晚期血压及血压变异性[J]. 中国计划生育学杂志, 2020, 28(4): 511-514. [Google Scholar]; ZHANG Ling, XU Xiaoying, HU Ping, et al. The blood pressure value and blood pressure variability of pregnant women with subclinical hypothyroidism during the third trimester of pregnancy[J]. Chinese Journal of Family Planning, 2020, 28(4): 511-514. [Google Scholar]
- 23. 王春梅. 孕早期甲状腺功能筛查预防妊娠合并亚临床甲减的效果及对妊娠结局的影响[J]. 实用妇科内分泌电子杂志, 2019, 6(14): 29, 39. [Google Scholar]; WANG Chunmei. Effect of thyroid function screening in early pregnancy to prevent pregnancy complicated with subclinical hypothyroidism and its effect on pregnancy outcome[J]. Electronic Journal of Practical Gynecologic Endocrinology, 2019, 6(14): 29, 39. [Google Scholar]
- 24. 刘丹霓, 王晓东, 周芷伊, 等. 危重孕产妇管理与孕产妇死亡防控[J]. 中华妇幼临床医学杂志(电子版), 2018, 14(1): 8-17. [Google Scholar]; LIU Danni, WANG Xiaodong, ZHOU Zhiyi, et al. Maternal near miss management and maternal mortality prevention[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics. Electronic Edition, 2018, 14(1): 8-17. [Google Scholar]
- 25. Vilchez G, Nazeer S, Kumar K, et al. Contemporary epidemiology and novel predictors of uterine rupture: a nationwide population-based study[J]. Arch Gynecol Obstet, 2017, 296(5): 286-287. [DOI] [PubMed] [Google Scholar]
- 26. 廖夏群. 妊娠期高血压疾病合并胎盘早剥对母婴产后恢复的影响[J]. 中外医学研究, 2014, 12(22): 126-127. [Google Scholar]; LIAO Xiaqun. Effect of hypertensive disorder complicating pregnancy complicated with placental abruption on postpartum recovery of mother and infant [J]. Chinese and Foreign Medical Research, 2014, 12(22): 126-127. [Google Scholar]
- 27. Rosenberg T, Pariente G, Sergienko R, et al. Critical analysis of risk factors and outcome of placenta previa[J]. Arch Gynecol Obstet, 2011, 284(1): 47-51. [DOI] [PubMed] [Google Scholar]
- 28. Hasegawa J, Sekizawa A, Farina A, et al. Location of the placenta or the umbilical cord insertion site in the lowest uterine segment is associated with low maternal blood pressure[J]. BJOG, 2011, 118(12): 1464-1469. [DOI] [PubMed] [Google Scholar]
- 29. Adam I, Haggaz AD, Mirghani OA, et al. Placenta previa and pre-eclampsia: analyses of 1 645 cases at Medani Maternity Hospital, Sudan[J]. Front Physiol, 2013, 4: 32. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30. 姚婧璠, 杨骏, 贾娇坤, 等. 欧洲高血压学会/欧洲心脏病学会: 高血压管理指南(第一部分)[J]. 中国卒中杂志, 2014, 9(1): 46-66. [Google Scholar]; YAO Jingfan, YANG Jun, JIA Jiaokun, et al. European Society of Hypertension/European Society of Cardiology: Guidelines for the management of hypertension (part I)[J]. Chinese Journal of Stroke, 2014, 9(1): 46-66. [Google Scholar]
- 31. Cecatti JG, Souza JP, Parpinelli MA, et al. Research on severe maternal morbidities and near-misses in Brazil: what we have learned[J]. Reprod Health Matters, 2007, 15(30): 125-133. [DOI] [PubMed] [Google Scholar]