Sibai B M, Mercer B M, Schiff E, Friedman S A
Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103.
Am J Obstet Gynecol. 1994 Sep;171(3):818-22. doi: 10.1016/0002-9378(94)90104-x.
Our purpose was to determine whether aggressive or expectant management of severe preeclampsia at 28 to 32 weeks is more beneficial to maternal and neonatal outcome.
Ninety-five eligible patients were randomly assigned to either aggressive (n = 46) or expectant management (n = 49). Aggressive management patients were prepared for delivery, either by cesarean or induction, 48 hours after glucocorticoids were administered. Expectant management patients were managed with bed rest, oral antihypertensives, and intensive antenatal fetal testing.
At the time of randomization there were no differences between the two groups in mean systolic blood pressure (170 +/- 9.7 vs 172 +/- 9.4 mm Hg), diastolic blood pressure (110 +/- 5.4 vs 112 +/- 4.2 mm Hg), proteinuria (3.0 +/- 2.3 vs 3.6 +/- 2.3 gm per 24 hours), and gestational age (30.4 +/- 1.6 vs 30.7 +/- 1.5 weeks) for the aggressive and expectant management groups. The average latency period in the expectant management group was 15.4 days (range 4 to 36), and this period was not affected by the amount of proteinuria at randomization. There was no eclampsia or perinatal death in either group. The two groups had similar incidences of abruptio placentae (4.1% vs 4.3%) and similar days of postpartum hospital stay. The expectant management group had a significantly higher gestational age at delivery (32.9 +/- 1.5 vs 30.8 +/- 1.7 weeks, p < 0.0001), higher birth weight, lower incidence of admission to the neonatal intensive care unit (76% vs 100%, p = 0.002), lower mean days of hospitalization in the intensive care unit (20.2 +/- 14 vs 36.6 +/- 17.4, p < 0.0001), and lower incidence of neonatal complications.
Expectant management, with close monitoring of mother and fetus at a perinatal center, reduces neonatal complications and neonatal stay in the newborn intensive care unit.
我们的目的是确定在28至32周时对重度子痫前期进行积极治疗或期待治疗对母婴结局是否更有益。
95名符合条件的患者被随机分配到积极治疗组（n = 46）或期待治疗组（n = 49）。积极治疗组患者在给予糖皮质激素48小时后，通过剖宫产或引产准备分娩。期待治疗组患者采用卧床休息、口服抗高血压药物及强化产前胎儿检测进行管理。
随机分组时，积极治疗组和期待治疗组在平均收缩压（170±9.7对172±9.4 mmHg）、舒张压（110±5.4对112±4.2 mmHg）、蛋白尿（3.0±2.3对3.6±2.3 g/24小时）和孕周（30.4±1.6对30.7±1.5周）方面无差异。期待治疗组的平均潜伏期为15.4天（范围4至36天），且该时期不受随机分组时蛋白尿水平的影响。两组均无子痫或围产儿死亡。两组胎盘早剥发生率相似（4.1%对4.3%），产后住院天数相似。期待治疗组分娩时孕周显著更高（32.9±1.5对30.8±1.7周，p<0.0001），出生体重更高，新生儿重症监护病房收治率更低（76%对100%，p = 0.002），重症监护病房平均住院天数更低（20.2±14对36.6±17.4，p<0.0001），新生儿并发症发生率更低。
在围产中心对母亲和胎儿进行密切监测的期待治疗可减少新生儿并发症及新生儿在新生儿重症监护病房的住院时间。
