Kim Lena Heesun, Cheng Yvonne W, Delaney Shani, Jelin Angie Child, Caughey Aaron B
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California 94143-0132, USA.
J Matern Fetal Neonatal Med. 2010 May;23(5):383-8. doi: 10.3109/14767050903168432.
To determine whether preeclampsia is associated with an increased risk of cesarean delivery if labor is induced.
This retrospective cohort study of 3505 women >or=24 weeks gestation with singleton pregnancies undergoing labor induction compares cesarean delivery rates between preeclamptics and non-preeclamptics. Multivariable logistic regression analysis was used to control for potential confounders including unfavorable cervix (Bishop score <or=5), method of labor induction, maternal age, parity, gestational age, race/ethnicity, epidural use, medical insurance, and marital status.
Among term nulliparous women undergoing labor induction, preeclamptics had a higher cesarean delivery rate then non-preeclamptics (81/267, 30% vs. 363/1568, 23%; p = 0.011), as did preeclamptic compared with non-preeclamptic women who were term and multiparous (10/64, 16% vs. 55/900, 6%, p = 0.003). Preterm preeclamptics also had more cesarean deliveries compared with non-preeclamptics among nulliparous (48/164, 29% vs. 16/245, 7%; p < 0.001) and multiparous (13/72, 18% vs. 18/225, 8%; p = 0.015) women. In multivariable analysis, preeclampsia still conferred an increased risk of cesarean delivery if labor was induced (adjusted odd ratio = 1.90, 95% CI 1.45-2.48).
Women with preeclampsia undergoing labor induction had higher cesarean delivery rates compared with non-preeclamptics regardless of parity or gestational age. However, the majority of women with preeclampsia still had successful vaginal deliveries.
确定引产时子痫前期是否与剖宫产风险增加相关。
这项回顾性队列研究纳入了3505名孕周≥24周的单胎妊娠且接受引产的女性，比较了子痫前期患者与非子痫前期患者的剖宫产率。采用多变量逻辑回归分析来控制潜在混杂因素，包括宫颈条件不佳（Bishop评分≤5）、引产方法、产妇年龄、产次、孕周、种族/族裔、硬膜外麻醉使用情况、医疗保险和婚姻状况。
在接受引产的足月未产妇中，子痫前期患者的剖宫产率高于非子痫前期患者（81/267，30% 对比363/1568，23%；p = 0.011），足月经产妇中，子痫前期患者与非子痫前期患者相比也是如此（10/64，16% 对比55/900，6%，p = 0.003）。在未产妇和经产妇中，早产子痫前期患者的剖宫产次数也多于非子痫前期患者（未产妇：48/164，29% 对比16/245，7%；p < 0.001；经产妇：13/72，18% 对比1十八/225，8%；p = 0.015）。在多变量分析中，如果进行引产，子痫前期仍然会增加剖宫产风险（调整后的优势比 = 1.90，95%置信区间1.45 - 2.48）。
无论产次或孕周如何，引产的子痫前期女性与非子痫前期女性相比，剖宫产率更高。然而，大多数子痫前期女性仍成功进行了阴道分娩。
