妊娠期间甲状腺功能减退症对母婴特征和结局的影响（妊娠结局与母体甲状腺功能减退症，MHPO-1）。
Maternal characteristics and outcomes affected by hypothyroidism during pregnancy (maternal hypothyroidism on pregnancy outcomes, MHPO-1).
机构信息
Section of Endocrinology, Department of Medicine, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi, Pakistan.
Department of Endocrinology, Ali Medical Center, Islamabad, Pakistan.
出版信息
BMC Pregnancy Childbirth. 2019 Dec 5;19(1):476. doi: 10.1186/s12884-019-2596-9.
BACKGROUND
Hypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Various studies have described the outcomes depending on geographical and international diagnostic criteria. No study has been conducted in this regard from the region of Pakistan. Therefore, we aim to report the clinical features and maternal outcomes of hypothyroid pregnancies and compare the maternal outcomes between uncontrolled and controlled TSH levels in the preconception as well as the gestational period.
METHODS
We conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital after ethical approval. We collected information on pregnant females who have diagnosed hypothyroidism before conception or during their antenatal period. We noted the maternal characteristics and maternal comorbidities. Laboratory data were recorded for thyroid stimulating hormone levels before conception and during gestation. We recorded maternal outcomes as pregnancy loss (including miscarriage, stillbirth/intrauterine death, medical termination of pregnancy and ectopic pregnancy), gestational hypertension, pre-eclampsia, postpartum hemorrhage, placental abruption, and modalities of delivery. Data analysis was performed on Statistical Package for the Social Sciences version 20.0.
RESULTS
Among 708 hypothyroid women 638 had live births. Postpartum hemorrhage was the most frequent maternal outcome (38.8%). The emergency cesarean section occurred in 23.4% of cases. We determined TSH levels in 53.2, 56.7, 61.7 and 66.6% of cases in preconception, 1st, 2nd, and 3rd trimester periods. A significant association existed between cesarean section and preconception thyrotropin levels > 2.5 mIU/L, whereas postpartum hemorrhage was significantly associated with thyrotropin levels > 2.5 mIU/L in the preconception and third trimester.
CONCLUSION
Successful live births in our patients were complicated by maternal postpartum hemorrhage and a frequent number of emergency cesarean section.
背景
妊娠甲状腺功能减退症是一个不断发展的研究领域，在筛查、管理和结局方面存在国际争议。各种研究根据地理位置和国际诊断标准描述了不同的结果。来自巴基斯坦地区的研究尚未开展。因此，我们旨在报告甲状腺功能减退症妊娠的临床特征和母儿结局，并比较孕前和妊娠期未控制和控制 TSH 水平的产妇结局。
方法
我们在经过伦理批准后，在 Aga Khan 大学医院进行了一项 718 例病例的横断面回顾性研究。我们收集了在受孕前或产前期间被诊断为甲状腺功能减退症的孕妇的信息。我们记录了产妇的特征和合并症。记录了孕前和妊娠期间的甲状腺刺激激素水平的实验室数据。我们将妊娠丢失（包括流产、死胎/宫内死亡、人工终止妊娠和异位妊娠）、妊娠期高血压、子痫前期、产后出血、胎盘早剥和分娩方式作为产妇结局进行记录。数据分析采用社会科学统计软件包 20.0 版进行。
结果
在 708 名甲状腺功能减退症女性中，有 638 名活产。产后出血是最常见的产妇结局（38.8%）。紧急剖宫产的发生率为 23.4%。我们在孕前、第 1、2 和 3 孕期分别有 53.2%、56.7%、61.7%和 66.6%的病例检测了 TSH 水平。剖宫产与孕前促甲状腺激素水平>2.5 mIU/L 之间存在显著相关性，而产后出血与孕前和孕晚期促甲状腺激素水平>2.5 mIU/L 之间存在显著相关性。
结论
在我们的患者中，成功的活产分娩与产妇产后出血和频繁的紧急剖宫产有关。
Zotero 插件