Carter Ebony B, Conner Shayna N, Cahill Alison G, Rampersad Roxane, Macones George A, Tuuli Methodius G
Washington University School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, United States.
Washington University School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, United States.
Pregnancy Hypertens. 2017 Apr;8:21-25. doi: 10.1016/j.preghy.2017.02.002. Epub 2017 Feb 17.
To estimate whether pregnancy outcomes in women with severe preeclampsia (sPE) with small for gestational age (SGA) fetuses differ from those with sPE without SGA or isolated SGA.
We conducted a retrospective cohort study of consecutive non-anomalous, livebirths in a single tertiary care institution from 2004 to 2008. We compared pregnancy outcomes in women who had sPE with SGA (birthweight<10th percentile), and sPE without SGA to those with isolated SGA as reference. The primary outcome was a neonatal composite score including low 5-min APGAR, NICU admission and neonatal death. Secondary outcomes were components of the composite as well as placental abruption and cesarean delivery. Analysis was repeated with SGA defined as birthweight<5th percentile. Multivariable logistic regression was used to adjust for confounders.
1905 women met inclusion criteria: 156 sPE with SGA, 746 sPE without SGA, 1003 isolated SGA. The risk of the neonatal composite score was higher for sPE with SGA (adjusted odds ratio [aOR] 2.29; 95% confidence interval [CI] 1.39-3.79) and sPE without SGA (aOR 3.66; 95% CI 2.71-4.93) compared to isolated SGA. The risk of abruption and cesarean were similarly increased in women with sPE with SGA and sPE without SGA compared to those with isolated SGA.
Similar to women with sPE without SGA fetus, women who have sPE with SGA are at a higher risk for several adverse maternal and neonatal outcomes compared to isolated SGA. These findings suggest that women with preeclampsia and SGA should be managed as sPE rather than as isolated SGA.
评估患有重度子痫前期（sPE）且胎儿小于孕周（SGA）的女性的妊娠结局是否与患有sPE但无SGA或单纯SGA的女性不同。
我们对2004年至2008年在一家三级医疗机构连续出生的非畸形活产儿进行了一项回顾性队列研究。我们将患有sPE且SGA（出生体重<第10百分位数）的女性、患有sPE但无SGA的女性的妊娠结局与以单纯SGA为对照的女性进行了比较。主要结局是一个新生儿综合评分，包括5分钟阿氏评分低、入住新生儿重症监护病房（NICU）和新生儿死亡。次要结局是综合评分的组成部分以及胎盘早剥和剖宫产。将SGA定义为出生体重<第5百分位数时重复进行分析。采用多变量逻辑回归来调整混杂因素。
1905名女性符合纳入标准：156例患有sPE且SGA，746例患有sPE但无SGA，1003例单纯SGA。与单纯SGA相比，患有sPE且SGA（调整后的优势比[aOR]为2.29；95%置信区间[CI]为1.39 - 3.79）和患有sPE但无SGA的女性（aOR为3.66；95%CI为2.71 - 4.93）的新生儿综合评分风险更高。与单纯SGA的女性相比，患有sPE且SGA和患有sPE但无SGA的女性发生胎盘早剥和剖宫产的风险同样增加。
与患有sPE但无SGA胎儿的女性类似，患有sPE且SGA的女性与单纯SGA相比，出现几种不良母婴结局的风险更高。这些发现表明，患有子痫前期和SGA的女性应作为sPE进行管理，而不是作为单纯SGA进行管理。
