Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Mercy Perinatal, Mercy Hospital for Women, Melbourne, VI, Australia.
Ultrasound Obstet Gynecol. 2023 Nov;62(5):660-667. doi: 10.1002/uog.26282. Epub 2023 Oct 9.
To assess whether coexisting fetal growth restriction (FGR) influences pregnancy latency among women with preterm pre-eclampsia undergoing expectant management. Secondary outcomes assessed were indication for delivery, mode of delivery and rate of serious adverse maternal and perinatal outcomes.
We conducted a secondary analysis of the Pre-eclampsia Intervention (PIE) and the Pre-eclampsia Intervention 2 (PI2) trial data. These randomized controlled trials evaluated whether esomeprazole and metformin could prolong gestation of women diagnosed with pre-eclampsia between 26 and 32 weeks of gestation undergoing expectant management. Delivery indications were deteriorating maternal or fetal status, or reaching 34 weeks' gestation. FGR (defined by Delphi consensus) at the time of pre-eclampsia diagnosis was examined as a predictor of outcome. Only placebo data from PI2 were included, as the trial showed that metformin use was associated with prolonged gestation. All outcome data were collected prospectively from diagnosis of pre-eclampsia to 6 weeks after the expected due date.
Of the 202 women included, 92 (45.5%) had FGR at the time of pre-eclampsia diagnosis. Median pregnancy latency was 6.8 days in the FGR group and 15.3 days in the control group (difference 8.5 days; adjusted 0.49-fold change (95% CI, 0.33-0.74); P < 0.001). FGR pregnancies were less likely to reach 34 weeks' gestation (12.0% vs 30.9%; adjusted relative risk (aRR), 0.44 (95% CI, 0.23-0.83)) and more likely to be delivered for suspected fetal compromise (64.1% vs 36.4%; aRR, 1.84 (95% CI, 1.36-2.47)). More women with FGR underwent a prelabor emergency Cesarean section (66.3% vs 43.6%; aRR, 1.56 (95% CI, 1.20-2.03)) and were less likely to have a successful induction of labor (4.3% vs 14.5%; aRR, 0.32 (95% CI, 0.10-1.00)), compared to those without FGR. The rate of maternal complications did not differ significantly between the two groups. FGR was associated with a higher rate of infant death (14.1% vs 4.5%; aRR, 3.26 (95% CI, 1.08-9.81)) and need for intubation and mechanical ventilation (15.2% vs 5.5%; aRR, 2.97 (95% CI, 1.11-7.90)).
FGR is commonly present in women with early preterm pre-eclampsia and outcome is poorer. FGR is associated with shorter pregnancy latency, more emergency Cesarean deliveries, fewer successful inductions and increased rates of neonatal morbidity and mortality. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
评估在接受期待治疗的患有早产先兆子痫的女性中，是否存在胎儿生长受限（FGR）会影响妊娠潜伏期。评估的次要结局包括分娩指征、分娩方式和严重母婴围产儿不良结局的发生率。
我们对 Pre-eclampsia Intervention（PIE）和 Pre-eclampsia Intervention 2（PI2）试验数据进行了二次分析。这两项随机对照试验评估了在 26 至 32 孕周接受期待治疗的诊断为先兆子痫的女性中，埃索美拉唑和二甲双胍是否可以延长妊娠时间。分娩指征为母体或胎儿状况恶化，或达到 34 孕周。在诊断先兆子痫时出现的 FGR（通过 Delphi 共识定义）被视为结局的预测因素。仅纳入了 PI2 的安慰剂数据，因为该试验表明二甲双胍的使用与妊娠时间延长有关。所有结局数据均从诊断先兆子痫开始前瞻性收集，直到预期分娩日期后 6 周。
在纳入的 202 名女性中，92 名（45.5%）在诊断先兆子痫时存在 FGR。FGR 组的中位妊娠潜伏期为 6.8 天，对照组为 15.3 天（差异 8.5 天；调整后 0.49 倍变化（95%CI，0.33-0.74）；P<0.001）。FGR 妊娠更不可能达到 34 孕周（12.0% vs 30.9%；调整后的相对风险（aRR），0.44（95%CI，0.23-0.83）），更有可能因疑似胎儿窘迫而分娩（64.1% vs 36.4%；aRR，1.84（95%CI，1.36-2.47））。更多的 FGR 孕妇接受了产前紧急剖宫产（66.3% vs 43.6%；aRR，1.56（95%CI，1.20-2.03）），而成功引产的可能性较小（4.3% vs 14.5%；aRR，0.32（95%CI，0.10-1.00））。与无 FGR 组相比，两组的母婴并发症发生率无显著差异。FGR 与更高的婴儿死亡率（14.1% vs 4.5%；aRR，3.26（95%CI，1.08-9.81））和需要插管和机械通气（15.2% vs 5.5%；aRR，2.97（95%CI，1.11-7.90））相关。
FGR 在患有早期早产先兆子痫的女性中很常见，结局更差。FGR 与妊娠潜伏期更短、更多的紧急剖宫产、更少的成功引产以及新生儿发病率和死亡率增加有关。
