Division of Maternal Fetal Medicine, Departments of Obstetrics, Gynecology, and Women's Health, Rutgers New Jersey Medical School, Newark, NJ.
Pediatrics, Rutgers New Jersey Medical School, Newark, NJ.
Am J Obstet Gynecol MFM. 2020 Aug;2(3):100125. doi: 10.1016/j.ajogmf.2020.100125. Epub 2020 Apr 28.
Previous research has focused mainly on neonatal outcomes associated with preterm and periviable delivery, but maternal outcomes with preterm delivery are less well described.
This study aimed to determine if early preterm delivery results in an increase in maternal morbidity.
This is a retrospective cohort study conducted at a tertiary care center over a 5-year time period. Subjects were women identified by review of neonatal intensive care unit admission logs. Women were included if they delivered between 23 0/7 and 28 6/7 weeks' gestation and their neonate was admitted to the neonatal intensive care unit. The prevalence of maternal morbidities was assessed, including blood transfusion, maternal infection, placental abruption, postpartum depression or positive depression screen, hemorrhage, and prolonged maternal postpartum hospitalization. A composite outcome comprising blood transfusion, maternal infectious morbidity, placental abruption, and postpartum depression was developed. Outcomes for women who delivered between 23 0/7 and 25 6/7 weeks' gestation (early group) and 26 0/7 and 28 6/7 weeks' gestation (late group) were compared. Multivariate logistic regression analysis was performed to evaluate contributors to the composite morbidity, controlling for confounding.
A total of 82 women met the inclusion criteria: 38 in the early group and 44 in the late group. Maternal demographics were similar between the groups. The early group was significantly more likely to experience composite maternal morbidity (60.5% vs 27.3%; P=.004) and infection (42.1% vs 13.6%; P=.006). Regression analysis determined that delivery at a later gestational age was associated with lower rates of composite morbidity (odds ratio, 0.6; 95% confidence interval, 0.41-0.83).
In this study, data suggest that maternal morbidity is higher with delivery at periviable gestational ages. Composite morbidity and maternal infection were more frequent in women who delivered at less than 26 weeks' gestation. The management of women at risk for delivery at early gestational ages should include a discussion of increased maternal complications.
先前的研究主要集中在与早产和极早产儿分娩相关的新生儿结局上，但早产分娩的产妇结局描述得较少。
本研究旨在确定早期早产是否会增加产妇发病率。
这是一项在一家三级保健中心进行的回顾性队列研究，时间跨度为 5 年。通过新生儿重症监护病房入院记录的审查来确定研究对象。如果产妇分娩时孕周在 23 0/7 至 28 6/7 周之间，且新生儿被收入新生儿重症监护病房，则纳入研究。评估了产妇发病率，包括输血、产妇感染、胎盘早剥、产后抑郁症或阳性抑郁筛查、出血和产妇产后住院时间延长。开发了一个包括输血、产妇感染发病率、胎盘早剥和产后抑郁症的复合结局。比较了在 23 0/7 至 25 6/7 周（早期组）和 26 0/7 至 28 6/7 周（晚期组）分娩的产妇的结局。进行了多变量逻辑回归分析，以评估复合发病率的影响因素，控制混杂因素。
共有 82 名产妇符合纳入标准：早期组 38 名，晚期组 44 名。两组产妇的人口统计学特征相似。早期组产妇发生复合产妇发病率（60.5%对 27.3%；P=.004）和感染（42.1%对 13.6%；P=.006）的风险显著更高。回归分析确定，分娩时的胎龄越晚，复合发病率的发生率越低（优势比，0.6；95%置信区间，0.41-0.83）。
在这项研究中，数据表明，在接近极早产儿分娩时，产妇发病率更高。在分娩时不足 26 周的产妇中，复合发病率和产妇感染更为常见。对于有早期妊娠分娩风险的妇女，应讨论增加的产妇并发症。
