Yefet Enav, Kuzmin Olga, Schwartz Naama, Basson Flora, Nachum Zohar
Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
Research Authority, Emek Medical Center, Afula, Israel.
J Obstet Gynaecol Res. 2018 Jun;44(6):1049-1056. doi: 10.1111/jog.13618. Epub 2018 Mar 8.
Elevated human chorionic gonadotropin (HCG) and alpha fetoprotein (AFP) have been linked to placental dysfunction and associated morbidities. We aimed to compare the induction of labor with expectant management at term in those pregnancies for the prevention of neonatal and maternal morbidities.
Women with second trimester HCG ≥ 2 and/or AFP ≥ 2 multiples of the median, without additional maternal or fetal complications, from their 38th gestational week were offered the choice of labor induction or expectant management. The primary outcomes were maternal composite outcome (composed of cesarean deliveries, pre-eclampsia or placental abruption) and neonatal composite outcome (composed of antenatal or neonatal death, Apgar score at 5 min < 7, admission to the neonatal intensive care unit, need for phototherapy, respiratory abnormalities, birth trauma or neonatal infection).
Of 305 women, 124 women chose to undergo labor induction, and 181 women chose expectant management. The composite maternal outcome in the expectant management group was twice the rate of the labor induction group, although it did not reach statistical significance (18 [10%] vs 6 [5%]; P = 0.1; relative risk [expectant/induced] 2.04; 95% confidence interval 0.8-5.0). Increased rate of phototherapy led to increased neonatal composite outcomes in the labor induction group compared with the expectant management group (34 [27%] vs 27 [15%], respectively = 0.007).
In pregnancies with elevated AFP and/or HCG, early term labor induction initiated a trend towards improvement in maternal outcome but increased the rate of mild neonatal morbidity. The statistical insignificance of the large effect on the maternal outcome might reflect the lack of statistical power. Further research is needed to address this limitation.
人绒毛膜促性腺激素（HCG）和甲胎蛋白（AFP）升高与胎盘功能障碍及相关发病情况有关。我们旨在比较足月时引产与期待治疗对预防新生儿和母亲发病情况的效果。
妊娠中期HCG≥2中位数倍数和/或AFP≥2中位数倍数、无其他母亲或胎儿并发症的女性，从妊娠第38周起可选择引产或期待治疗。主要结局为母亲综合结局（包括剖宫产、子痫前期或胎盘早剥）和新生儿综合结局（包括产前或新生儿死亡、5分钟阿氏评分<7、入住新生儿重症监护病房、需要光疗、呼吸异常、出生创伤或新生儿感染）。
305名女性中，124名女性选择引产，181名女性选择期待治疗。期待治疗组的母亲综合结局发生率是引产组的两倍，尽管未达到统计学显著性（18例[10%]对6例[5%]；P = 0.1；相对风险[期待治疗/引产]2.04；95%置信区间0.8 - 5.0）。与期待治疗组相比，引产组光疗率增加导致新生儿综合结局增加（分别为34例[27%]对27例[15%]，P = 0.007）。
在AFP和/或HCG升高的妊娠中，早期引产有改善母亲结局的趋势，但增加了轻度新生儿发病的发生率。对母亲结局的较大影响缺乏统计学显著性可能反映了统计效能不足。需要进一步研究来解决这一局限性。
