Harper Lorie M, Biggio Joseph R, Anderson Sarah, Tita Alan T N
Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, the University of Alabama at Birmingham, Birmingham, Alabama.
Obstet Gynecol. 2016 Jun;127(6):1101-1109. doi: 10.1097/AOG.0000000000001435.
To identify the gestational age of planned delivery in pregnancies complicated by chronic hypertension that minimizes the risk of perinatal death and severe adverse events.
This was a retrospective cohort study of all singletons complicated by hypertension. Detailed patient-level information was collected by chart review, including indication for delivery. Planned delivery at 36-36 6/7, 37-37 6/7, 38-38 6/7, and 39-39 6/7 weeks of gestation was compared with expectant management beyond each respective gestational age. Patients were excluded for fetal anomalies, inaccurate dating, and major medical problems other than hypertension, diabetes, or renal disease. The primary outcome was a composite of stillbirth, neonatal death, assisted ventilation, cord pH less than 7.0, 5-minute Apgar score of 3 or less, and neonatal seizures. Secondary outcomes were preeclampsia, severe preeclampsia, primary cesarean delivery, and neonatal length of stay greater than 5 days. Groups were compared using Student's t test and χ tests.
Six hundred eighty-three women with hypertension reached 36 weeks of gestation. Patients with planned delivery at less than 39 weeks of gestation were more likely to have baseline renal disease. Before 37 weeks of gestation, planned delivery was associated with a statistically significant increase in the primary composite adverse neonatal outcome (10.0% compared with 2.6%, P=.04); after 38 weeks of gestation, expectant management was associated with a nonstatistically significant increase in the primary composite outcome (0% compared with 2.3%, P=.40). Expectant management beyond 39 weeks of gestation was associated with a statistically significant increase in severe preeclampsia (0% compared with 10.3%, P=.001).
Expectant management beyond 39 weeks of gestation was associated with increasing incidence of severe preeclampsia; planned delivery before 37 weeks of gestation was associated with an increase in adverse neonatal outcomes. Further well-powered studies are needed to delineate the optimal gestational age of delivery.
确定患有慢性高血压的孕妇计划分娩的孕周，以使围产期死亡和严重不良事件的风险降至最低。
这是一项对所有患有高血压的单胎妊娠进行的回顾性队列研究。通过病历审查收集详细的患者层面信息，包括分娩指征。将妊娠36 - 36⁶/₇周、37 - 37⁶/₇周、38 - 38⁶/₇周和39 - 39⁶/₇周的计划分娩与超过各相应孕周的期待治疗进行比较。排除胎儿异常、孕周计算不准确以及除高血压、糖尿病或肾病以外的重大医疗问题的患者。主要结局是死产、新生儿死亡、辅助通气、脐动脉血pH值低于7.0、5分钟阿氏评分3分及以下和新生儿惊厥的综合结果。次要结局是子痫前期、重度子痫前期、首次剖宫产以及新生儿住院时间超过5天。使用学生t检验和χ²检验对各组进行比较。
683名患有高血压的女性达到妊娠36周。妊娠小于39周计划分娩的患者更可能有基线肾病。在妊娠37周之前，计划分娩与主要综合不良新生儿结局的统计学显著增加相关（10.0% 对比2.6%，P = 0.04）；妊娠38周之后，期待治疗与主要综合结局的非统计学显著增加相关（0% 对比2.3%，P = 0.40）。妊娠39周之后的期待治疗与重度子痫前期的统计学显著增加相关（0% 对比10.3%，P = 0.001）。
妊娠39周之后的期待治疗与重度子痫前期发病率增加相关；妊娠37周之前计划分娩与不良新生儿结局增加相关。需要进一步开展有足够效力的研究来确定最佳分娩孕周。
