Olivier S E, De Waard L, Muller C J B, Gebhardt G S
Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
S Afr Med J. 2021 Apr 30;111(5):437-443. doi: 10.7196/SAMJ.2021.v111i5.15201.
Obstetricians are cognisant of the serious nature of hypertensive disorders in pregnancy. Despite a 17% overall reduction in maternal deaths in South Africa between 2011 and 2016, there was a 14% increase in deaths due to hypertension. Delivery is the only known cure for pre-eclampsia, but the question regarding the safest route of delivery remains difficult to answer.
To determine the success rate of induction of labour (IoL) in patients with early-onset pre-eclampsia with severe features (EOPES) before 34 weeks' gestation. Furthermore, the data from the induction group were compared with those of the caesarean delivery (CD) groups where patients were not eligible for IoL. Additional objectives were to identify variables that could influence the success rate, to determine whether any delivery method was associated with increased morbidity, to assess the short-term maternal and neonatal outcomes, and to make recommendations for future decision-making regarding delivery for women with EOPES.
In this single-institution retrospective observational study, all cases in which a decision for delivery was made before 34 weeks 0 days of gestation (or the infant's birthweight was ≤2 000 g with uncertain gestation) at Tygerberg Hospital, Cape Town, between 1 January and 30 June 2017 were identified from the electronic birth register. The cohort fitting the inclusion criteria was subdivided into IoL and CD groups.
From a total of 3 938 deliveries, 168 patients met the inclusion criteria. IoL was indicated in 55 cases, resulting in 20 vaginal deliveries (VDs) (36%) and 35 CDs (64%). The remaining 113 patients were not candidates for IoL; of these, 89 required emergency CDs and 24 had semi-elective CDs. In the IoL group with abnormal umbilical artery Dopplers (UADs) there was 1 VD, and 4 CDs were performed for fetal compromise. Of cases with an estimated fetal weight (EFW) ≤3rd centile, emergency CD was required in 24 (65%), and 8 (22%) were considered for IoL, in 6 of which CD was required.
Of the EOPES population, 36% had successful IoL that culminated in VD. VD was more likely to occur with fetal growth appropriate for gestational age. The likelihood of CD increased if the UAD was abnormal, if the EFW was ≤3rd centile or if eclampsia was present. The decision to induce should be considered carefully in these circumstances.
产科医生深知妊娠高血压疾病的严重性。尽管2011年至2016年间南非孕产妇死亡总数下降了17%，但因高血压导致的死亡人数却增加了14%。分娩是已知的子痫前期唯一治疗方法，但关于最安全的分娩途径问题仍难以回答。
确定妊娠34周前早发型重度子痫前期（EOPES）患者引产的成功率。此外，将引产组的数据与不符合引产条件而行剖宫产（CD）组的数据进行比较。其他目的包括确定可能影响成功率的变量，确定是否有任何分娩方式与发病率增加相关，评估母婴短期结局，并就EOPES患者未来分娩决策提出建议。
在这项单机构回顾性观察研究中，从开普敦泰格伯格医院2017年1月1日至6月30日的电子出生登记册中识别出所有在妊娠34周0天前（或婴儿出生体重≤2000g且孕周不确定）做出分娩决定的病例。符合纳入标准的队列被分为引产组和剖宫产组。
在总共3938例分娩中，168例患者符合纳入标准。55例患者被建议引产，其中20例经阴道分娩（VD）（36%），35例行剖宫产（64%）。其余113例患者不适合引产；其中89例需要急诊剖宫产，24例行半择期剖宫产。在引产组中，脐动脉多普勒（UAD）异常的患者中有1例经阴道分娩，4例行剖宫产以处理胎儿窘迫。估计胎儿体重（EFW）≤第3百分位数的病例中，24例（65%）需要急诊剖宫产，8例（22%）考虑引产，其中6例需要剖宫产。
在EOPES人群中，36%的患者引产成功并最终经阴道分娩。胎儿生长符合孕周时更有可能经阴道分娩。如果UAD异常、EFW≤第3百分位数或出现子痫，剖宫产的可能性增加。在这些情况下，应谨慎考虑引产决定。
