Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
BJOG. 2020 Sep;127(10):1241-1248. doi: 10.1111/1471-0528.16247. Epub 2020 Apr 29.
To examine the outcomes of planned induction of labour versus spontaneous onset of labour among women using prophylactic-dose low-molecular weight heparin (LMWH) therapy.
Retrospective cohort study.
University hospital.
Women receiving antepartum prophylactic LMWH therapy undergoing a trial of vaginal delivery.
Charts from 2018-2019 were reviewed.
Duration of anticoagulation interruption and eligibility to receive neuraxial anaesthesia.
Data from 199 women were analysed; 78 (39.2%) were admitted following spontaneous onset of labour and 121 (60.8%) underwent planned induction of labour. Compared to women who underwent planned induction of labour, women who presented with spontaneous onset of labour had a shorter median admission-to-delivery interval (4.7 versus 29.3 hours, P < 0.001). Similarly, intervals from the last LMWH injection to delivery (25.8 versus 48.2 hours, P < 0.001) and to the first postpartum LMWH injection (41.2 versus 63.7 hours, P < 0.001) were shorter. Among those with spontaneous onset of labour, 69 (88.5%) were eligible to receive neuraxial anaesthesia. Rates of postpartum haemorrhage and blood transfusion were similar between the groups. No thrombotic events were encountered in those with spontaneous onset of labour, but four (3.3%) women who delivered following induction of labour developed a postpartum thrombotic event.
Planned induction of labour was associated with a higher risk of postpartum thrombotic events than was spontaneous onset of labour (4 of 121 [3.3%] versus 0 of 78 [0%]), presumably due to prolonged duration of anticoagulation interruption, although the difference was not statistically significant. Allowing spontaneous onset of labour was associated with comparable rates of bleeding complications, and only a low proportion (9 of 78, 11.5%) were not eligible to receive neuraxial anaesthesia.
Planned induction among women using prophylactic LMWH therapy might increase the risk of thromboembolic complications.
研究使用预防性低分子肝素（LMWH）治疗的女性中计划引产与自然临产的结局。
回顾性队列研究。
大学医院。
接受产前预防性 LMWH 治疗并进行阴道分娩尝试的女性。
回顾 2018-2019 年的病历。
抗凝中断时间和接受椎管内麻醉的资格。
分析了 199 名女性的数据；78 名（39.2%）女性自发临产入院，121 名（60.8%）行计划性引产。与行计划性引产的女性相比，自发临产的女性中位入院至分娩时间更短（4.7 小时与 29.3 小时，P<0.001）。同样，从最后一次 LMWH 注射到分娩的时间（25.8 小时与 48.2 小时，P<0.001）和到第一次产后 LMWH 注射的时间（41.2 小时与 63.7 小时，P<0.001）也更短。在自发临产的女性中，69 名（88.5%）有资格接受椎管内麻醉。两组产后出血和输血发生率相似。自发临产组未发生血栓事件，但 4 名（3.3%）引产的女性发生产后血栓事件。
与自然临产相比，计划性引产与产后血栓事件风险增加相关（121 例中有 4 例[3.3%]与 78 例中 0 例[0%]），可能是由于抗凝中断时间延长，但差异无统计学意义。允许自然临产与出血并发症发生率相当，仅有少数（78 例中的 9 例，11.5%）不适合接受椎管内麻醉。
使用预防性 LMWH 治疗的女性中计划引产可能会增加血栓栓塞并发症的风险。
