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乙型肝炎后肝硬化女性妊娠结局的回顾性研究
作者:王晓娟   梁冬竹  易为  刘敏 
单位:首都医科大学附属北京地坛医院 妇产科 北京 100015 
关键词:乙型肝炎病毒 肝硬化 妊娠 
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出版年,卷(期):页码:2015,7(2):33-36
摘要:

摘要:目的 探讨乙型肝炎后肝硬化对女性妊娠结局的影响。方法 利用医院电子病历系统回顾性收集在北京地坛医院分娩的乙型肝炎后肝硬化孕妇,按1∶3配对收集同期慢性HBV感染孕妇为对照组,比较2组孕妇孕期及产时各种并发症发生率,以及2组新生儿出生时发育情况。 结果 共收集肝硬化孕妇25例,均为代偿期肝硬化。肝硬化孕妇中19例孕前使用抗病毒治疗,2例孕中期开始抗病毒治疗。肝硬化组孕妇平均分娩时间(258.92 ± 16.42)天(其中14例在孕37周及以后分娩),产后出血发生率24%,与对照组相比有显著差异(P = 0.003,P = 0.000)。妊娠期糖尿病、羊水过少、羊水过多、羊水Ⅲ度粪染、妊娠高血压疾病的发生率2组孕妇相比无显著差异(P值均大于0.05)。两组新生儿畸形发生率无明显差异,肝硬化组新生儿窒息发生率12%,与对照组相比有显著差异(P = 0.014)。结论 代偿期肝硬化患者在抗病毒治疗及密切临床监测下妊娠结局良好,可足月分娩,但应注意产后出血和新生儿窒息的发生。

Abstract: Objective To discuss the pregnancy outcomes in women with liver cirrhosis after hepatitis B. Methods Pregnant women with compensated liver cirrhosis after hepatitis B who delivered in Beijing Ditan Hospital were retrospectively collected through the HIS system. According to 1∶3 pairing, the corresponding period pregnant women with chronic HBV infection were collected as control group. The incidence of complications in pregnancy women of the two groups were compared. The development of the neonatus were compared too. Results Totally, 25 cases of pregnant women with compensated liver cirrhosis were collected, 19 cases were given antiviral therapy before pregnancy and two cases started antiviral therapy at the second trimester. The average delivery time of women with liver cirrhosis was (258.92 ± 16.42) days (including 14 cases at 37 weeks of pregnancy and after), and the rate of postpartum hemorrhage was 24%, the differences were significant compared with the control group (P = 0.003, P = 0.000). There were no significant differences in the incidence of gestational diabetes mellitus, postpartum hemorrhage, polyhydramnios, oligohydramnios, meconium staining of the amniotic fluid Ⅲ degrees and hypertensive disorder in pregnancy (P > 0.05). To the infants, it had no significant difference on the rate of congenital abnormality in the two groups (P > 0.05). The rate of neonate asphyxia was 12% in infants whose mother were with liver cirrhosis, which had significant difference with the control group. Conclusions Under antiviral therapy and closely clinical monitoring, the pregnant outcomes in patients with decompensated cirrhosis is good, some of them can full-term delivery. But we should pay attention to the postpartum hemorrhage and neonatal asphyxia.

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