Hastie Roxanne, Bergman Lina, Akhter Tansim, Sandström Anna, Wikström Anna-Karin, Hesselman Susanne
Mercy Perinatal, Mercy Hospital for Women, MelbourneAustralia; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, GothenburgSweden.
Eur J Obstet Gynecol Reprod Biol. 2020 Aug;251:114-118. doi: 10.1016/j.ejogrb.2020.05.024. Epub 2020 May 20.
Preeclampsia is a severe obstetric complication affecting 2-8% of pregnancies. There is a common belief that women with preeclampsia experience a shorter duration of labor, where it is thought that increased inflammation that occurs with the disease facilitates labor. However, little evidence exists to support or refute this. Thus, we undertook a register-based cohort study investigating the association between hypertensive disorders of pregnancy and labor duration.
This was a Swedish register-based cohort study of nulliparous women with spontaneous or induced onset of labor at >34 weeks of gestation with a singleton fetus in cephalic presentation. Information of duration of labor was retrieved from electronic birth records and compared between women with hypertensive disorders and normotensives pregnancies. Data was represented as mean adjusted difference in hours (adjusted for pre-gestational disorders, maternal characteristics and mode of delivery) and adjusted hazard ratios (aHR), with an event defined as vaginal birth and women with intrapartum caesarean section censored. An aHR >1 indicated shorter duration of labor.
Among 101,531 women, 5548 (5.5%) developed a hypertensive disorder of pregnancy. The overall mean duration of labor was 9.43 (SD 5.32) hours. Women with hypertensive disorders experienced a shorter duration of labor compared to normotensive women, with an adjusted mean difference of -0.68 h (95% CI -0.90, -0.47) for gestational hypertension and -1.53 h (95% CI -1.72, -1.35) for preeclampsia. This corresponded to an aHR of 1.05 (95% CI 1.01, 1.10) and 1.12 (95% CI 1.08, 1.17), respectively. However, when we confined the analysis to those who labored spontaneously, the presence of hypertensive disorders did not alter duration of labor (aHR 0.98, 95% CI 0.95,1.01). Only women who were induced and also had hypertensive disorders experienced a shorter duration of labor (aHR 1.07, 95% CI 1.04,1.09).
Hypertensive disorders did not alter labor duration among women with spontaneous onset of labor, however an association was observed among women who were induced.
子痫前期是一种严重的产科并发症，影响2%-8%的妊娠。人们普遍认为，子痫前期女性的产程较短，认为该疾病伴随的炎症增加促进了分娩。然而，几乎没有证据支持或反驳这一点。因此，我们进行了一项基于登记处的队列研究，调查妊娠高血压疾病与产程之间的关联。
这是一项基于瑞典登记处的队列研究，研究对象为妊娠>34周、单胎头先露、自然发动或引产的初产妇。从电子出生记录中获取产程信息，并在患有高血压疾病的女性和血压正常的孕妇之间进行比较。数据以小时为单位表示平均校正差异（校正孕前疾病、产妇特征和分娩方式）和校正风险比（aHR），事件定义为经阴道分娩，产时剖宫产的女性被 censored。aHR>1表示产程较短。
在101531名女性中，5548名（5.5%）发生了妊娠高血压疾病。总体平均产程为9.43（标准差5.32）小时。与血压正常的女性相比，患有高血压疾病的女性产程较短，妊娠期高血压的校正平均差异为-0.68小时（95%可信区间-0.90，-0.47），子痫前期为-1.53小时（95%可信区间-1.72，-1.35）。这分别对应aHR为1.05（95%可信区间1.01，1.10）和1.12（95%可信区间1.08，1.17）。然而，当我们将分析局限于自然分娩的女性时，高血压疾病的存在并未改变产程（aHR 0.98，95%可信区间0.95，1.01）。只有引产且患有高血压疾病的女性产程较短（aHR 1.07，95%可信区间1.04，1.09）。
高血压疾病并未改变自然发动分娩女性的产程，但在引产女性中观察到了相关性。
