晚期早产中的孕产妇风险因素及产科并发症

Maternal risk factors and obstetric complications in late preterm prematurity.

作者信息

Trilla Cristina C, Medina Maria C, Ginovart Gemma, Betancourt Jocelyn, Armengol Josep A, Calaf Joaquim

机构信息

Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:105-9. doi: 10.1016/j.ejogrb.2014.05.030. Epub 2014 Jun 2.

DOI:10.1016/j.ejogrb.2014.05.030

PMID:24965989

Abstract

OBJECTIVE

Late preterm prematurity has been related to poorer neonatal outcomes. However, research has focused on the neonatal outcomes of late preterm infants, maternal characteristics of these births have been less evaluated. The aim of the study was to compare maternal risk factors and obstetric complications in late preterm births (LPTB) and term births. These factors were also assessed comparing spontaneous LPTB with medically-indicated LPTB.

STUDY DESIGN

We conducted a retrospective cohort study with two groups. All singleton LPTB occurred at our University Hospital between January 1, 2009 and December 31, 2010 were included in the first cohort (n=171). A comparison cohort of term births was configured in a ratio 2:1 (n=342). Well-dated pregnancies without congenital malformations, congenital infections or chromosome abnormalities were eligible. LPTB were classified into two groups, spontaneous LPTB and medically-indicated LPTB following delivery indications. Statistical analysis of categorical variables was performed using either χ(2) or Fisher's exact. Continuous variables were compared using the Student's t-test.

RESULTS

Women with LPTB had more medical conditions than women with term births (29% vs 15.7%; P=0.002). Prior preterm births (9.7% vs 2%; P<0.001), prior adverse obstetric outcomes (6.9% vs 2.3%; P<0.001), and obstetric complications were also more frequent in LPTB than in term births. However, no differences were found in maternal medical conditions when spontaneous LPTB and medically-indicated LPTB were compared. Women with medically-indicated LPTB were older (33.69 vs 31.07; P=0.003) and mainly nulliparous (75.8% vs 49.4%; P=0.002). Obstetric complications were more frequent in medically-indicated LPTB than in spontaneous LPTB.

CONCLUSIONS

Maternal risk factors and obstetric complications are significantly higher in LPTB than in term births. These factors should be considered to identify women at risk for either spontaneous or medically-indicated LPTB.

摘要

目的

晚期早产与较差的新生儿结局相关。然而，研究主要集中在晚期早产儿的新生儿结局，对这些分娩的产妇特征评估较少。本研究的目的是比较晚期早产（LPTB）和足月产的产妇风险因素及产科并发症。还对自然发生的LPTB与医学指征性LPTB进行比较评估了这些因素。

研究设计

我们进行了一项两组的回顾性队列研究。2009年1月1日至2010年12月31日在我们大学医院发生的所有单胎LPTB纳入第一队列（n = 171）。以2:1的比例构建足月产的对照队列（n = 342）。符合条件的是孕期明确且无先天性畸形、先天性感染或染色体异常的孕妇。根据分娩指征，LPTB分为两组，自然发生的LPTB和医学指征性LPTB。分类变量的统计分析采用χ(2)检验或Fisher精确检验。连续变量采用Student t检验进行比较。

结果

LPTB产妇的内科疾病比足月产产妇更多（29%对15.7%；P = 0.002）。既往早产（9.7%对2%；P < 0.001）、既往不良产科结局（6.9%对2.3%；P < 0.001）以及产科并发症在LPTB中也比足月产更常见。然而，比较自然发生的LPTB和医学指征性LPTB时，产妇内科疾病方面未发现差异。医学指征性LPTB的产妇年龄更大（33.69对31.07；P = 0.003）且主要为初产妇（75.8%对49.4%；P = 0.002）。医学指征性LPTB的产科并发症比自然发生的LPTB更常见。