Boston University School of Medicine, Boston, MA, USA.
Boston Medical Center, Department of Obstetrics and Gynecology, Boston, MA, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):10036-10043. doi: 10.1080/14767058.2022.2086796. Epub 2022 Jun 15.
The gold standard intrapartum treatment for preeclampsia with severe features is magnesium sulfate in order to provide prophylaxis against eclampsia. However, though magnesium sulfate is known to have a relaxant effect on uterine muscle, there have been variable reports in the literature in regard to the association between magnesium and obstetric hemorrhage (OBH).
We aim to compare OBH incidence in patients with hypertensive disease of pregnancy (HDP) with or without exposure to intrapartum magnesium sulfate.
We performed a retrospective cohort study of all deliveries at our institution associated with a diagnosis of hypertensive disease of pregnancy (HDP) (e.g. chronic and gestational hypertension, preeclampsia with or without severe features, eclampsia, or HELLP) from January 1, 2018 to December 31, 2019. The category of HDP diagnosis was determined by a detailed chart review by trained chart abstractors. The primary outcome was total quantitative blood loss (QBL) and the rate of obstetric hemorrhage. Secondary outcomes included a composite of obstetric hemorrhage-related maternal morbidity outcomes (OBH-M), the individual composite components and the incidence of additional hemorrhage-related interventions (e.g. uterotonics and surgical interventions). We also examined the same primary and secondary outcomes in a stratified analysis based on delivery mode (i.e. vaginal deliveries only and cesarean deliveries only).
Of 791 patients with a diagnosis of HDP, 411 patients received magnesium sulfate for eclampsia prophylaxis and 380 patients did not receive magnesium sulfate. For all delivery modes, there was a significantly higher QBL ( < .01), increased rate of OBH ( = .04) and increased OBH-M ( < .01) in deliveries associated with intrapartum exposure to magnesium compared to those without. However, our stratified analysis by delivery mode demonstrated that magnesium-related hemorrhage risk only persisted for vaginal deliveries (QBL < .01; OBH aOR 1.47, 95% CI: 0.75-2.85; OBH-M aOR 1.47, 95% CI 1.00-7.55) with no significant hemorrhage-related differences among cesareans with or without magnesium exposure (QBL = .51; OBH aOR 1.45, 95% CI: 0.85-2.47; OBH-M 1.50 95% CI: 0.70-3.23).
Intrapartum exposure to magnesium sulfate use was associated with an increase in QBL and risk of OBH-M in vaginal deliveries, but not associated with any hemorrhage-related outcome differences in cesarean deliveries. More research is needed to explore the effects of hypertensive disease, magnesium exposure, and delivery mode on obstetric hemorrhage risk.
对于有严重特征的子痫前期，金标准的分娩期治疗是硫酸镁，以预防子痫。然而，尽管硫酸镁对子宫肌肉有松弛作用，但文献中有关于硫酸镁与产科出血（OBH）之间关联的不同报告。
我们旨在比较有或没有接受分娩期硫酸镁暴露的妊娠高血压疾病（HDP）患者的 OBH 发生率。
我们对 2018 年 1 月 1 日至 2019 年 12 月 31 日在我院分娩的所有与妊娠高血压疾病（HDP）相关的病例（如慢性和妊娠期高血压、子痫前期伴或不伴严重特征、子痫或 HELLP）进行了回顾性队列研究。HDP 诊断类别通过训练有素的图表摘要员进行详细的图表审查确定。主要结局是总定量失血量（QBL）和产科出血率。次要结局包括产科出血相关产妇发病率结局的复合（OBH-M）、复合成分和额外出血相关干预的发生率（如宫缩剂和手术干预）。我们还根据分娩方式（即阴道分娩和剖宫产）进行了分层分析，检查了相同的主要和次要结局。
在 791 名患有 HDP 的患者中，411 名患者接受硫酸镁预防子痫，380 名患者未接受硫酸镁。对于所有分娩方式，与未接受硫酸镁的分娩相比，接受硫酸镁分娩的患者的 QBL 明显更高（ < .01），OBH 发生率更高（ = .04），OBH-M 更高（ < .01）。然而，我们的分娩方式分层分析表明，只有在阴道分娩中，硫酸镁相关出血风险才持续存在（QBL < .01；OBH 的比值比 [aOR] 1.47，95%置信区间：0.75-2.85；OBH-M 的 aOR 1.47，95%置信区间 1.00-7.55），而在接受或不接受硫酸镁的剖宫产中，没有明显的出血相关差异（QBL = .51；OBH 的 aOR 1.45，95%置信区间：0.85-2.47；OBH-M 1.50，95%置信区间：0.70-3.23）。
分娩期暴露于硫酸镁与 QBL 增加和阴道分娩中 OBH-M 的风险增加相关，但与剖宫产中任何出血相关的结局差异无关。需要进一步研究来探讨高血压疾病、硫酸镁暴露和分娩方式对产科出血风险的影响。
