Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
The Biostatistics Center, The George Washington University, Washington, District of Columbia.
Am J Perinatol. 2018 Jun;35(7):624-631. doi: 10.1055/s-0037-1608787. Epub 2017 Nov 30.
To compare the risks of adverse maternal and neonatal outcomes associated with spontaneous (SPTB) versus indicated preterm births (IPTB).
A secondary analysis of a multicenter trial of vitamin C and E supplementation in healthy low-risk nulliparous women. Outcomes were compared between women with SPTB (due to spontaneous membrane rupture or labor) and those with IPTB (due to medical or obstetric complications). A primary maternal composite outcome included: death, pulmonary edema, blood transfusion, adult respiratory distress syndrome (RDS), cerebrovascular accident, acute tubular necrosis, disseminated intravascular coagulopathy, or liver rupture. A neonatal composite outcome included: neonatal death, RDS, grades III or IV intraventricular hemorrhage (IVH), sepsis, necrotizing enterocolitis (NEC), or retinopathy of prematurity.
Of 9,867 women, 10.4% ( = 1,038) were PTBs; 32.7% ( = 340) IPTBs and 67.3% ( = 698) SPTBs. Compared with SPTB, the composite maternal outcome was more frequent in IPTB-4.4% versus 0.9% (adjusted odds ratio [aOR], 4.0; 95% confidence interval [CI], 1.4-11.8), as were blood transfusion and prolonged hospital stay (3.2 and 3.7 times, respectively). The frequency of composite neonatal outcome was higher in IPTBs (aOR, 1.8; 95% CI, 1.1-3.0), as were RDS (1.7 times), small for gestational age (SGA) < 5th percentile (7.9 times), and neonatal intensive care unit (NICU) admission (1.8 times).
Adverse maternal and neonatal outcomes were significantly more likely with IPTB than with SPTB.
比较自发性早产（SPTB）与指征性早产（IPTB）相关的母婴不良结局风险。
对一项维生素 C 和 E 补充剂用于健康低危初产妇的多中心试验进行二次分析。比较自发性胎膜早破或临产导致的 SPTB 妇女与因医疗或产科并发症导致的 IPTB 妇女的结局。主要母体复合结局包括：死亡、肺水肿、输血、成人呼吸窘迫综合征（ARDS）、脑血管意外、急性肾小管坏死、弥漫性血管内凝血或肝破裂。新生儿复合结局包括：新生儿死亡、ARDS、III 或 IV 级脑室内出血（IVH）、败血症、坏死性小肠结肠炎（NEC）或早产儿视网膜病变。
在 9867 名妇女中，10.4%（1038 名）为早产；32.7%（340 名）为 IPTB，67.3%（698 名）为 SPTB。与 SPTB 相比，IPTB-4 的母体复合结局更常见（4.4%比 0.9%，调整后的优势比[aOR]，4.0；95%置信区间[CI]，1.4-11.8），输血和住院时间延长也更常见（分别为 3.2 和 3.7 倍）。IPTB 的新生儿复合结局发生率更高（aOR，1.8；95% CI，1.1-3.0），包括呼吸窘迫综合征（1.7 倍）、小于胎龄儿（SGA）<第 5 百分位数（7.9 倍）和新生儿重症监护病房（NICU）入住（1.8 倍）。
与 SPTB 相比，IPTB 母婴不良结局的发生风险显著更高。
