Department of Obstetrics and Gynecology, Galilee Medical Center, 2210001, Nahariya, Israel.
Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Arch Gynecol Obstet. 2024 Oct;310(4):1919-1926. doi: 10.1007/s00404-024-07682-0. Epub 2024 Aug 6.
To examine maternal, obstetrical, and neonatal outcomes of pregnancies complicated by major fetal anomalies.
A 10 year retrospective cohort study at a tertiary university hospital compared maternal and obstetrical outcomes between women with singleton pregnancies complicated by major fetal anomalies, and a control group with non-anomalous fetuses.
For the study compared to the control group, the median gestational age at delivery was lower: 37.0 vs. 39.4 weeks (p < 0.001); and the preterm delivery rates were higher, both at < 37 weeks (46.2 vs. 6.2%, p < 0.001) and < 32 weeks (15.4 vs. 1.2%, p < 0.001). For the study compared to the control group, the placental abruption rate was higher (6.8 vs. 0.9%, p = 0.002); 87.5 vs. 100% occurred before labor. For the respective groups, the mean gestational ages at abruption were 32.8 ± 1.3 and 39.9 ± 1.7 weeks (p = 0.024); and cesarean section and postpartum hemorrhage rates were: 53.8 vs. 28.3% (p < 0.001) and 11.3 vs. 2.8% (p = 0.001), respectively. For the respective groups, hypertensive disorders of pregnancy rates were 9.5 vs. 2.1% (p = 0.004), stillbirth rates were 17.1 vs. 0.3% (p < 0.001), and neonatal death rates 12.5 vs. 0.0% (p < 0.001). Major fetal anomalies were found to be associated with adverse maternal outcomes (OR = 2.47, 95% CI 1.50-4.09, p < 0.001). Polyhydramnios was identified as an independent risk factor in a multivariate analysis that adjusted for fetal anomalies, conception by IVF, and primiparity for adverse maternal outcomes (OR = 4.7, 95% CI 1.7-13.6, p < 0.001).
Pregnancies with major fetal anomalies should be treated as high-risk due to the increased likelihood of adverse maternal and neonatal outcomes.
探讨伴有严重胎儿畸形的妊娠的母婴及新生儿结局。
这是一项在一所三级大学医院进行的 10 年回顾性队列研究，比较了患有严重胎儿畸形的单胎妊娠孕妇与非畸形胎儿对照组的母婴结局。
与对照组相比，研究组的中位分娩孕周较低：37.0 周 vs. 39.4 周（p<0.001）；早产率更高，包括<37 周（46.2% vs. 6.2%，p<0.001）和<32 周（15.4% vs. 1.2%，p<0.001）。与对照组相比，研究组胎盘早剥率更高（6.8% vs. 0.9%，p=0.002）；87.5%的胎盘早剥发生在分娩前。对于两组，早剥的平均孕周分别为 32.8±1.3 周和 39.9±1.7 周（p=0.024）；剖宫产和产后出血率分别为 53.8% vs. 28.3%（p<0.001）和 11.3% vs. 2.8%（p=0.001）。对于两组，妊娠高血压疾病的发生率分别为 9.5% vs. 2.1%（p=0.004），死胎率分别为 17.1% vs. 0.3%（p<0.001），新生儿死亡率分别为 12.5% vs. 0.0%（p<0.001）。严重胎儿畸形与不良母婴结局相关（OR=2.47，95%CI 1.50-4.09，p<0.001）。多胎羊水过多在调整了胎儿畸形、体外受精受孕和初产妇后，在多变量分析中被确定为不良母婴结局的独立危险因素（OR=4.7，95%CI 1.7-13.6，p<0.001）。
由于严重胎儿畸形妊娠母婴及新生儿结局不良的可能性增加，应将其视为高危妊娠。
