Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, Tel Aviv, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2024 Jul;310(1):453-459. doi: 10.1007/s00404-023-07263-7. Epub 2023 Oct 30.
We aimed to examine the association of clinical risk factors and placental lesions, in gestations complicated with preeclampsia, with the need for antihypertensive treatment in the early postpartum period.
The computerized files and placental reports of all singleton deliveries at 24.0-42.0 weeks complicated by preeclampsia were reviewed between January 2013 and October 2020. Obstetric characteristics and placental lesions were compared between patients who required antihypertensive treatment in the early postpartum period and those who did not (control group). Placentas were classified into maternal and fetal malperfusion lesions and inflammatory responses.
As compared to controls (n = 200), the anti-hypertensive treatment group (n = 95) was characterized by increased rates of preterm birth, preeclampsia with severe features, and cesarean delivery (p < 0.001 for all). More placental hematomas (p = 0.01) and placental maternal vascular lesions (p = 0.03) were observed in the antihypertensive treatment group as compared to controls. In adjusted logistic regression analysis, gestational age (OR 0.86, 95% CI 0.79-0.93, p = 0.001) and preeclampsia with severe features (OR 8.89, 95% CI 3.18-14.93 p < 0.001) were found to be independently associated with the need for postpartum antihypertensive treatment.
Placental vascular lesions are more common in preeclamptic patients who need postpartum antihypertensive treatment, yet only early onset of preeclampsia with severe features was found to be independently associated with antihypertensive treatment in the early postpartum period.
本研究旨在探讨子痫前期患者的临床危险因素和胎盘病变与产后早期降压治疗需求的关系。
回顾性分析 2013 年 1 月至 2020 年 10 月期间 24.0-42.0 周因子痫前期而分娩的所有单胎妊娠患者的计算机文件和胎盘报告。比较产后早期需要降压治疗（治疗组）和未接受降压治疗的患者（对照组）的产科特征和胎盘病变。胎盘分为母体和胎儿灌注不良病变及炎症反应。
与对照组（n=200）相比，降压治疗组（n=95）早产、重度子痫前期和剖宫产率较高（均 p<0.001）。与对照组相比，降压治疗组的胎盘血肿（p=0.01）和胎盘母体血管病变（p=0.03）更多。多因素逻辑回归分析显示，胎龄（OR 0.86，95%CI 0.79-0.93，p=0.001）和重度子痫前期（OR 8.89，95%CI 3.18-14.93，p<0.001）与产后降压治疗的需求独立相关。
需要产后降压治疗的子痫前期患者胎盘血管病变更常见，但只有重度子痫前期的早发与产后早期降压治疗独立相关。
