Frolova Antonina I, Stout Molly J, Carter Ebony B, Macones George A, Cahill Alison G, Raghuraman Nandini
Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.
Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.
Am J Obstet Gynecol MFM. 2021 Jan;3(1):100282. doi: 10.1016/j.ajogmf.2020.100282. Epub 2020 Nov 27.
The maternal habitus in the setting of obesity makes external monitoring of the fetal heart rate and contractions suboptimal, and internal monitors may be utilized more often in this population. Obesity is a risk factor for obstetrical infectious complications, but it is unknown whether the use of internal monitors in this population is associated with additional risks.
This study aimed to investigate the association between the use of an intrauterine pressure catheter and a fetal scalp electrode and maternal infectious morbidity among women with obesity.
This secondary analysis of a prospective cohort study included women with singleton gestations admitted for labor at ≥37 weeks' gestation at a tertiary care institution from 2010 to 2014. Obesity was defined as a body mass index of ≥30 kg/m. The primary outcome was a composite maternal infectious morbidity, which included peripartum maternal fever, chorioamnionitis, and endomyometritis. Secondary outcomes were cesarean delivery and individual components of the maternal infectious composite. Multivariable logistic regression was used to compare the rates of infectious maternal morbidity, cesarean delivery, or operative vaginal delivery between patients with and without internal monitors, while adjusting for the confounders. An interaction term was included in the logistic regression models to test whether the relationship between the internal monitors and cesarean delivery or infectious morbidity was modified by the presence or absence of obesity.
Of the 8482 women who met the inclusion criteria for the study, 4727 (55.7%) had obesity and 3755 (44.3%) did not have obesity. The women with obesity were more likely to have internal monitors placed during labor than those without obesity (65.4% vs 50.5%; P<.001). The use of internal monitors was associated with an increased risk for the composite maternal infectious morbidity (9.9% vs 4.1%; P<.01 and adjusted odds ratio, 2.08; 95% confidence interval, 1.70-2.55). Women with obesity had a weaker association between the use of internal monitors and maternal infectious morbidity than women without obesity (P value for interaction of .02). The incidence of cesarean delivery was also significantly higher among women who had internal monitors placed during their labor course (adjusted odds ratio, 2.84; 95% confidence interval, 2.46-3.28), and this interaction was not modified by obesity.
Although a higher proportion of women with obesity have internal monitors placed during their labor course, they are not more susceptible to maternal infectious morbidity as a result of internal monitor use. Providers should not limit the necessary internal monitor use in women with obesity on the basis of concerns for maternal infectious morbidity.
肥胖产妇的身体状况使得对胎儿心率和宫缩的外部监测效果欠佳，在这一人群中可能更常使用内部监测器。肥胖是产科感染并发症的一个危险因素，但在这一人群中使用内部监测器是否会带来额外风险尚不清楚。
本研究旨在调查肥胖女性使用宫内压力导管和胎儿头皮电极与产妇感染性发病之间的关联。
这项前瞻性队列研究的二次分析纳入了2010年至2014年在一家三级医疗机构因≥37周妊娠入院分娩的单胎妊娠女性。肥胖定义为体重指数≥30kg/m²。主要结局是产妇感染性发病的综合指标，包括围产期产妇发热、绒毛膜羊膜炎和子宫内膜炎。次要结局是剖宫产以及产妇感染综合指标的各个组成部分。采用多变量逻辑回归比较有和没有使用内部监测器的患者之间产妇感染性发病、剖宫产或阴道助产的发生率，同时对混杂因素进行校正。逻辑回归模型中纳入了一个交互项，以检验肥胖的存在与否是否会改变内部监测器与剖宫产或感染性发病之间的关系。
在符合研究纳入标准的8482名女性中，4727名（55.7%）患有肥胖症，375�名（44.3%）没有肥胖症。肥胖女性在分娩期间放置内部监测器的可能性高于非肥胖女性（65.4%对50.5%；P<0.001）。使用内部监测器与产妇感染性发病综合指标的风险增加相关（9.9%对4.1%；P<0.01，校正比值比为2.08；95%置信区间为1.70 - 2.55）。与非肥胖女性相比，肥胖女性使用内部监测器与产妇感染性发病之间的关联较弱（交互作用P值为0.02）。在分娩过程中放置内部监测器的女性剖宫产发生率也显著更高（校正比值比为2.84；95%置信区间为2.46 - 3.28），且这种交互作用不受肥胖的影响。
尽管肥胖女性在分娩过程中放置内部监测器的比例较高，但她们并不会因使用内部监测器而更易发生产妇感染性发病。医疗服务提供者不应基于对产妇感染性发病的担忧而限制对肥胖女性必要的内部监测器使用。
