Department of Obstetrics and Gynaecology, Takamatsu Red Cross Hospital, Takamatsu, Japan.
Department of Obstetrics and Gynaecology, Otsu Red Cross Hospital, Otsu, Japan.
J Obstet Gynaecol. 2021 Jan;41(1):60-65. doi: 10.1080/01443615.2019.1706160. Epub 2020 Feb 6.
We collected data from all the women with singleton pregnancies complicated by early-onset severe preeclampsia between 2008 and 2018 to identify the factor(s) that contributed to favourable neonatal outcome. Thirty women delivered the neonates with favourable outcome and the remaining 21 women delivered those with unfavourable outcome. Univariate logistic regression analysis revealed that gestational age at diagnosis ≥28 weeks (crude odds ratio [OR], 6.00), protocol-based management (crude OR 5.83), use of magnesium sulphate (crude OR, 6.00), gestational age at delivery ≥32 weeks (crude OR, 31.90), and birthweight ≥1000 g (crude OR, 10.36) were significantly associated with favourable neonatal outcome. Among these five factors, multivariate logistic regression analysis extracted gestational age at delivery ≥32 weeks (adjusted OR, 17.62) as an only independent factor contributing to favourable neonatal outcome. These data suggest that prolongation of pregnancy up to 32 weeks of gestation is a key factor to improve neonatal outcome in the expectant management of early-onset severe preeclampsia.This study was approved by the ethics committee of Otsu Red Cross Hospital (reference number: 363, date of approval: April 28th, 2016).Impact statement It has been demonstrated that expectant management for the women with early-onset severe preeclampsia is associated with decreased neonatal morbidity as compared to the aggressive management, suggesting that prolongation of the pregnancy period contributes to improved neonatal outcomes. Among multiple elements composing expectant management for the women with early-onset severe preeclampsia, 'gestational age at delivery ≥32 weeks' was extracted as an only independent factor that significantly contributes to favourable neonatal outcomes. Importantly, small for gestational age was not significantly associated with poor neonatal outcomes. The obstetrician should aim to prolong the pregnancies complicated by early-onset severe preeclampsia up to 32 gestational weeks even in the presence of foetal growth restriction, as far as maternal conditions allow. Such management policy could contribute to improvement of the neonatal outcomes.
我们收集了 2008 年至 2018 年间所有患有早发型重度子痫前期的单胎妊娠女性的数据，以确定有助于新生儿结局良好的因素。30 名产妇分娩的新生儿结局良好，其余 21 名产妇分娩的新生儿结局不良。单因素 logistic 回归分析显示，诊断时的孕周≥28 周（粗优势比[OR]，6.00）、基于方案的管理（粗 OR，5.83）、硫酸镁的使用（粗 OR，6.00）、分娩时的孕周≥32 周（粗 OR，31.90）和出生体重≥1000g（粗 OR，10.36）与新生儿结局良好显著相关。在这五个因素中，多因素 logistic 回归分析提取出分娩时的孕周≥32 周（调整后的 OR，17.62）作为唯一独立的有助于新生儿结局良好的因素。这些数据表明，将妊娠延长至 32 孕周是改善早发型重度子痫前期期待管理中新生儿结局的关键因素。本研究经大津红十字医院伦理委员会批准（编号：363，批准日期：2016 年 4 月 28 日）。
与积极管理相比，早发型重度子痫前期女性的期待管理与新生儿发病率降低相关，这表明妊娠延长有助于改善新生儿结局。在早发型重度子痫前期女性的期待管理中，有多个组成要素，“分娩时的孕周≥32 周”被提取为唯一独立的显著有助于新生儿结局良好的因素。重要的是，胎儿生长受限与不良新生儿结局无显著相关性。只要产妇情况允许，产科医生应尽量将早发型重度子痫前期孕妇的妊娠延长至 32 孕周。这种管理策略有助于改善新生儿结局。
