Parc Enora, Benin Amelie, Lecarpentier Edouard, Goffinet François, Lepercq Jacques
Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France.
Department of Obstetrics Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil, France.
J Gynecol Obstet Hum Reprod. 2023 Jan;52(1):102498. doi: 10.1016/j.jogoh.2022.102498. Epub 2022 Nov 4.
To identify risk factors for moderate or severe hypoxic-ischemic encephalopathy (HIE), or neonatal death in clinical placental abruption.
A nested case-control study within a cohort of singleton pregnancies complicated by placental abruption with a live born infant at two academic reference centers in France, from 2006 to 2019. Cases were patients who gave birth to an infant with moderate or severe HIE or death within 28 days (HIE/death group), and controls were patients whose infant did not have any of these outcomes (no-HIE group). Independent risk factors were identified by logistic regression. Binary decision tree discriminant (CART) analysis was performed to define high-risk subgroups of HIE or death.
Among 152 patients, the infants of 44 (29%) had HIE or death. Out-of-hospital placental abruption and fetal bradycardia at admission were more frequent in cases than in controls: 39 (89%) vs 61 (56%), p < .01 and 24 (59%) vs 19 (18%), p < .01, respectively. In multivariate analysis, out-of-hospital placental abruption (aOR, 7.05; 95% CI, 1.94-25.66) and bradycardia at admission (aOR, 8.60; 95% CI, 2.51-29.42) were independently associated with an increased risk of HIE or death. The combination of out-of-hospital placental abruption and bradycardia was the highest risk situation associated with HIE or death (67%). The decision-to-delivery interval was 15 [12-20] minutes among cases.
Out-of-hospital placental abruption combined with bradycardia at admission was associated with a major risk of moderate or severe HIE or death. An optimal decision-to-delivery interval does not guarantee the absence of an adverse neonatal outcome.
确定临床胎盘早剥中发生中度或重度缺氧缺血性脑病（HIE）或新生儿死亡的危险因素。
在法国两个学术参考中心进行的一项巢式病例对照研究，研究对象为2006年至2019年期间单胎妊娠并发胎盘早剥且婴儿存活的队列。病例为分娩出患有中度或重度HIE或在28天内死亡的婴儿的患者（HIE/死亡组），对照为其婴儿未出现上述任何结局的患者（无HIE组）。通过逻辑回归确定独立危险因素。进行二元决策树判别（CART）分析以定义HIE或死亡的高危亚组。
152例患者中，44例（29%）的婴儿发生了HIE或死亡。院外胎盘早剥和入院时胎儿心动过缓在病例中比在对照中更常见：分别为39例（89%）对61例（56%），p<0.01和24例（59%）对19例（18%），p<0.01。在多变量分析中，院外胎盘早剥（调整后比值比，7.05；95%置信区间，1.94 - 25.66）和入院时心动过缓（调整后比值比，8.60；95%置信区间，2.51 - 29.42）与HIE或死亡风险增加独立相关。院外胎盘早剥和心动过缓同时存在是与HIE或死亡相关的最高风险情况（67%）。病例组的决定分娩间隔时间为15[12 - 20]分钟。
院外胎盘早剥合并入院时心动过缓与中度或重度HIE或死亡的主要风险相关。最佳的决定分娩间隔时间并不能保证避免不良新生儿结局。
