Li Jia, Shao Xuecheng, Song Shurong, Liang Qian, Liu Yang, Qi Xiaojin
Department of Obstetrics, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170, China.
Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China.
BMC Pregnancy Childbirth. 2020 Nov 26;20(1):735. doi: 10.1186/s12884-020-03407-8.
Mothers with hypertensive disorder of pregnancy can be managed with either immediate or delayed induction of labour with expectant monitoring of both mother and baby. There are risks and benefits associated with both the type of interventions. Hence, this review was conducted to compare outcomes of immediate and delayed induction of labour among women with hypertensive disorder of pregnancy based on disease severity and gestational age.
We conducted systematic searches in various databases including Medline, Cochrane Controlled Register of Trials (CENTRAL), Scopus, and Embase from inception until October 2019.Cochrane risk of bias tool was used to assess the quality of published trials. A meta-analysis was performed with random-effects model and reported pooled Risk ratios (RR) with 95% confidence intervals (CIs).
Fourteen randomized controlled trials with 4244 participants were included. Majority of the studies had low or unclear bias risks. Amongst late onset mild pre-eclampsia patients, the risk of renal failure was significantly lower with immediate induction of labour (pooled RR: 0.36; 95%CI: 0.14 to 0.92). In severe pre-eclampsia patients, immediate induction of labour significantly reduced the risk of having small-for-gestational age babies compared to delayed induction of labour (pooled RR: 0.49; 95%CI: 0.29-0.84).Delayed induction was found to significantly reduce the risk of neonatal respiratory distress syndrome risk among late onset mild pre-eclampsia patients (pooled RR: 2.15; 95%CI: 1.14 to 4.06) None of the other outcomes demonstrated statistically significant difference between the two interventions.
Delayed induction of labour with expectant monitoring may not be inferior to immediate induction of labour in terms of neonatal and maternal outcomes. Expectant approach of management for late onset mild pre-eclampsia patients may be associated with decreased risk of neonatal respiratory distress syndrome, while immediate induction of labour among severe pre-eclampsia patients is associated with reduced risk of small-for-gestational age babies and among mild pre-eclampsia patients, it is associated with reduced risk of severe renal impairment.
妊娠高血压疾病的母亲可通过立即引产或延迟引产并对母婴进行期待监测来处理。这两种干预方式都有风险和益处。因此，本综述旨在根据疾病严重程度和孕周比较妊娠高血压疾病女性立即引产和延迟引产的结局。
我们在包括Medline、Cochrane对照试验注册库（CENTRAL）、Scopus和Embase在内的多个数据库中进行了系统检索，检索时间从数据库建立至2019年10月。使用Cochrane偏倚风险工具评估已发表试验的质量。采用随机效应模型进行荟萃分析，并报告合并风险比（RR）及95%置信区间（CI）。
纳入了14项随机对照试验，共4244名参与者。大多数研究的偏倚风险较低或不明确。在晚发型轻度子痫前期患者中，立即引产的肾衰竭风险显著较低（合并RR：0.36；95%CI：0.14至0.92）。在重度子痫前期患者中，与延迟引产相比，立即引产显著降低了小于胎龄儿的风险（合并RR：0.49；95%CI：0.29 - 0.84）。发现延迟引产显著降低了晚发型轻度子痫前期患者新生儿呼吸窘迫综合征的风险（合并RR：2.15；95%CI：1.14至4.06）。其他结局在两种干预措施之间均未显示出统计学上的显著差异。
在新生儿和母亲结局方面，期待监测下的延迟引产可能并不逊于立即引产。对于晚发型轻度子痫前期患者，期待管理方法可能与新生儿呼吸窘迫综合征风险降低相关，而重度子痫前期患者立即引产与小于胎龄儿风险降低相关，轻度子痫前期患者立即引产与严重肾功能损害风险降低相关。
