先天性膈疝胎儿内镜气管闭塞术中套管插入部位对胎膜早破早产的影响。

Effect of cannula insertion site during fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia on preterm prelabor rupture of membranes.

作者信息

Cordier A-G, Badr D A, Basurto D, Russo F, Deprest J, Orain E, Eixarch E, Otano J, Gratacos E, Moraes De Luna Freire Vargas A, Peralta C F A, Jani J C, Benachi A

机构信息

Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, APHP, Clamart, France.

Centre de Référence Maladie Rare, Hernie de Coupole Diaphragmatique, Clamart, France.

出版信息

Ultrasound Obstet Gynecol. 2024 Apr;63(4):529-535. doi: 10.1002/uog.27548.

DOI:10.1002/uog.27548

PMID:38051135

Abstract

OBJECTIVE

To assess whether the cannula insertion site on the maternal abdomen during fetal endoscopic tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH) was associated with preterm prelabor rupture of membranes (PPROM) before balloon removal.

METHODS

This was a multicenter retrospective study of consecutive pregnancies with isolated left- or right-sided CDH that underwent FETO in four centers between January 2009 and January 2021. The site for balloon insertion was categorized as above or below the umbilicus. One propensity score was analyzed in both groups to calculate an average treatment effect (ATE) by inverse probability of treatment weighting. Logistic regression and Cox proportional hazard regression including the ATE weights were performed to examine the effect size of entry point on the frequency and timing of PPROM before balloon removal.

RESULTS

A total of 294 patients were included. The mean ± SD gestational age at PPROM was 33.45 ± 2.01 weeks and the mean rate of PPROM before balloon removal was 25.9% (76/294). Gestational age at FETO was later in the below-umbilicus group (mean ± SD, 29.47 ± 1.29 weeks vs 29.00 ± 1.25 weeks; P = 0.002) and the duration of FETO was longer in the above-umbilicus group (median, 14.49 min (interquartile range (IQR), 8.00-21.00 min) vs 11.00 min (IQR, 7.00-14.49 min); P = 0.002). After balancing for possible confounding factors, trocar entry point below the umbilicus did not increase the risk of PPROM before balloon removal (adjusted odds ratio, 1.56 (95% CI, 0.89-2.74); P = 0.120) and had no effect on the timing of PPROM before balloon removal (adjusted hazard ratio, 1.56 (95% CI, 0.95-2.55); P = 0.080).

CONCLUSION

摘要

目的

评估先天性膈疝（CDH）胎儿内镜气管阻塞术（FETO）期间产妇腹部套管插入部位与球囊移除前胎膜早破（PPROM）是否相关。

方法

这是一项多中心回顾性研究，纳入了2009年1月至2021年1月期间在四个中心接受FETO的连续孤立性左侧或右侧CDH妊娠病例。球囊插入部位分为脐上或脐下。对两组分析一个倾向评分，通过治疗加权的逆概率计算平均治疗效果（ATE）。进行包括ATE权重的逻辑回归和Cox比例风险回归，以检验进入点对球囊移除前PPROM的频率和时间的效应大小。

结果

共纳入294例患者。PPROM时的平均±标准差孕周为33.45±2.01周，球囊移除前PPROM的平均发生率为25.9%（76/294）。FETO时的孕周在脐下组较晚（平均±标准差，29.47±1.29周对29.00±1.25周；P = 0.002），FETO持续时间在脐上组较长（中位数，14.49分钟（四分位数间距（IQR），8.00 - 21.00分钟）对11.00分钟（IQR，7.00 - 14.49分钟）；P = 0.002）。在平衡可能的混杂因素后，脐下套管进入点并未增加球囊移除前PPROM的风险（调整后的优势比，1.56（95%CI，0.89 - 2.74）；P = 0.120），且对球囊移除前PPROM的时间无影响（调整后的风险比，1.56（95%CI，0.95 - 2.55）；P = 0.080）。