Schoen Corina N, Moreno Sindy C, Saccone Gabriele, Graham Nora M, Hand Lauren C, Maruotti Giuseppe M, Martinelli Pasquale, Berghella Vincenzo, Roman Amanda
a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA.
b Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine , University of Naples Federico II , Naples , Italy.
J Matern Fetal Neonatal Med. 2018 Aug;31(15):1993-1999. doi: 10.1080/14767058.2017.1333101. Epub 2017 Jun 8.
To determine if women with preterm superimposed preeclampsia without severe features can be successfully and safely triaged to outpatient management.
This was a multicenter, retrospective, cohort study of singleton pregnancies with superimposed preeclampsia without severe features diagnosed before 37 weeks managed outpatient versus inpatient at Thomas Jefferson University (Philadelphia, PA) and at University of Naples (Naples, Italy) from January 2008 to July 2015. The attending physician made the decision to manage outpatient or inpatient at his or her discretion. The primary outcome was composite maternal morbidity defined as development of at least one of the following: severe features, HELLP syndrome, placental abruption, eclampsia, postpartum hemorrhage, intensive care unit admission, or maternal death. Logistic regression, presented as adjusted odds ratio (aOR) with the 95% of confidence interval (CI) was performed.
A total of 365 women with superimposed preeclampsia without severe features before 37 weeks were analyzed. 198 (54.2%) were managed outpatient, and 167 (45.8%) were managed inpatient. Women managed as outpatients had a similar rate of maternal morbidity compared to those managed as inpatients (36.4% versus 41.3%, aOR 0.82, 95%CI 0.55-1.17). Fetuses from women in the outpatient group had a significantly lower risk of small for gestational age (17.7% versus 29.3%; aOR 0.53, 95%CI 0.30-0.84), and lower risk of admission to neonatal intensive care unit (40.4% versus 47.9%; aOR 0.72, 95%CI 0.39-0.95) compared to women managed as inpatients.
Low risk women with superimposed preeclampsia without severe features can be triaged to outpatient management without increased maternal morbidity.
确定无严重特征的早产合并子痫前期女性患者能否成功且安全地分诊至门诊管理。
这是一项多中心、回顾性队列研究，研究对象为2008年1月至2015年7月在托马斯·杰斐逊大学（宾夕法尼亚州费城）和那不勒斯大学（意大利那不勒斯）诊断为37周前无严重特征的早产合并子痫前期的单胎妊娠患者，这些患者分别接受门诊或住院治疗。主治医师自行决定患者接受门诊或住院治疗。主要结局是综合孕产妇发病率，定义为出现以下至少一种情况：严重特征、HELLP综合征、胎盘早剥、子痫、产后出血、入住重症监护病房或孕产妇死亡。采用逻辑回归分析，以调整优势比（aOR）及95%置信区间（CI）表示。
共分析了365例37周前无严重特征的早产合并子痫前期女性患者。198例（54.2%）接受门诊治疗，167例（45.8%）接受住院治疗。与住院治疗的患者相比，门诊治疗的患者孕产妇发病率相似（36.4%对41.3%，aOR 0.82，95%CI 0.55 - 1.17）。与住院治疗的女性相比，门诊组女性所分娩胎儿小于胎龄的风险显著更低（17.7%对29.3%；aOR 0.53，95%CI 0.30 - 0.84），入住新生儿重症监护病房的风险也更低（40.4%对47.9%；aOR 0.72，95%CI 0.39 - 0.95）。
无严重特征的早产合并子痫前期的低风险女性患者可分诊至门诊管理，且不会增加孕产妇发病率。
