Huang Lu, Chen Zhong, Li Jiawen, Chen Yuanyuan, Yin Ke, Chen Yu, Hu Lingqing, Zheng Xiaomin, Zhou Tao, Zhu Yunlong, Chen Daozhen, Zhong Nanbert
Department of Obstetrics, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China.
New York State Developmental Disorders Basic Research Institute, Staten Island, NY, USA.
Transl Pediatr. 2021 Oct;10(10):2602-2613. doi: 10.21037/tp-21-458.
Preterm birth (PTB) rates have been increased significantly in recent years, mostly due to obstetric intervention. This study presents the incidence of PTB in community hospitals by assessing the association between pregnancy complications and iatrogenic PTB.
A total of 6,693 pregnancies were enrolled in the Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University. They were divided into two groups (<35 and ≥35 years of age) to examine the effect of maternal age on PTB. Binary logistic and multiple linear regression analyses were used to assess the relationship between PTB and pregnancy complications.
This study provided the incidence of PTB and found that PP, PROM, and ICP increased the risk of PTB, indicating that pregnancy complications have led to the iatrogenic PTB and contributed to the high rate of PTB, especially in the group of advanced-age pregnant women. The prevalence of PTB was 9.53%. Placenta previa (PP), premature rupture of membranes (PROM), and intrahepatic cholestasis of pregnancy (ICP) were significantly associated with PTB. Among all the risk factors, hypertension, disease in pregnancy, premature PROM, and PP were observed as independent key factors for iatrogenic PTBs. In the advanced-age group, PP and pPROM increased the risk of PTB.
It is often necessary to terminate a pregnancy in community hospitals to balance the safety of the fetus and the maternal comorbid symptoms, which has led to nosocomial premature delivery. Therefore, high-risk pregnancies should be carefully evaluated and comprehensively treated with caution to balance the preterm rate and the safety of the pregnant woman and fetus, and the pros and cons of the outcomes, which has brought a challenge to an obstetrician to reduce the proportion of iatrogenic PTB.
近年来早产（PTB）率显著上升，主要归因于产科干预。本研究通过评估妊娠并发症与医源性早产之间的关联，呈现社区医院中早产的发生率。
南京医科大学附属无锡妇幼保健院共纳入6693例妊娠病例。将其分为两组（年龄<35岁和≥35岁）以研究产妇年龄对早产的影响。采用二元逻辑回归和多元线性回归分析评估早产与妊娠并发症之间的关系。
本研究得出了早产的发生率，并发现前置胎盘（PP）、胎膜早破（PROM）和妊娠期肝内胆汁淤积症（ICP）增加了早产风险，表明妊娠并发症导致了医源性早产，并促使早产率升高，尤其是在高龄孕妇群体中。早产的发生率为9.53%。前置胎盘（PP）、胎膜早破（PROM）和妊娠期肝内胆汁淤积症（ICP）与早产显著相关。在所有风险因素中，高血压、妊娠疾病、胎膜早破和前置胎盘被视为医源性早产的独立关键因素。在高龄组中，前置胎盘和胎膜早破增加了早产风险。
在社区医院，为平衡胎儿安全与产妇合并症状，常需终止妊娠，这导致了医院内早产。因此，应对高危妊娠进行仔细评估并谨慎综合治疗，以平衡早产率与孕妇和胎儿的安全以及结局的利弊，这给产科医生降低医源性早产比例带来了挑战。
