子痫前期终止妊娠的临床决策：时机选择、母婴结局与综合管理策略
Clinical Decision-Making Regarding Termination of Pregnancy in Preeclampsia: Timing Selection, Maternal-Fetal Outcomes, and Comprehensive Management Strategies

子痫前期是妊娠期特有的严重并发症，全球发病率约2%~8%，每年导致约7万名孕产妇及50万婴儿死亡，其在发展中国家风险更高。子痫前期发病机制复杂，涉及免疫、炎症及遗传等多因素，引发全身小动脉痉挛及胎盘血流不足，导致胎儿生长受限及母体多器官损伤。研究发现子痫前期可显著增加母婴不良结局风险：孕妇可能出现子痫、HELLP综合征、器官衰竭；胎儿则面临早产、发育迟缓甚至死亡。终止妊娠是唯一根治手段，但终止妊娠方式以及时机需个体化评估，剖宫产因安全性较高渐成主流，尤其适用于病情不稳定或宫颈未成熟者。本研究表明子痫前期患者需结合孕周、并发症及胎儿状况综合决策，以降低围产儿死亡率及母体远期健康风险(如心血管疾病)。尽管缺乏明确终止时机与器官功能指标的直接关联，但综合评估体系可为临床提供重要指导。
Preeclampsia is a severe and specific complication of pregnancy, with a global incidence rate of approximately 2%~8%. It leads to approximately 70,000 maternal deaths and 500,000 infant deaths annually, with a higher risk in developing countries. The pathogenesis of preeclampsia is complex, involving multiple factors such as immunity, inflammation, and genetics, which induce systemic small artery spasms and insufficient placental blood flow, resulting in fetal growth restriction and maternal multi-organ damage. Studies have found that preeclampsia can significantly increase the risk of adverse maternal-fetal outcomes: pregnant women may develop eclampsia, HELLP syndrome, or organ failure; fetuses are at risk of preterm birth, growth retardation, or even death. Termination of pregnancy is the only definitive treatment, but the method and timing of termination require individualized assessment. Cesarean section has gradually become the mainstream due to its higher safety, particularly for patients with unstable conditions or an unripe cervix. Our research indicates that patients with preeclampsia need to make comprehensive decisions based on gestational age, complications, and fetal status to reduce perinatal mortality and long-term maternal health risks (such as cardiovascular diseases). Although there is a lack of a clear direct correlation between the timing of termination and organ function indicators, a comprehensive assessment system can provide important guidance for clinical practice.