Magann E F, Roberts W E, Perry K G, Chauhan S P, Blake P G, Martin J N
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505.
Am J Obstet Gynecol. 1994 Jun;170(6):1828-32; discussion 1832-4.
Our purpose was to investigate factors relevant to mode of delivery for patients with preterm (< 34 weeks) gestation complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP).
The pregnancies of 189 patients with HELLP syndrome and delivery < 34 weeks' gestation between January 1980 and October 1991 were studied retrospectively. Only patients with class 1 (platelet nadir < or = 50,000 per microliter, n = 83) and class 2 (platelet nadir > 50,000 to < or = 100,000 per microliter, n = 106) HELLP syndrome were included. Maternal and perinatal factors relevant to type of delivery were reviewed.
The incidence of cesarean delivery for all patients was 76.2% (primary rate 72.4%). Abdominal delivery occurred equally between class 1 (78.3%) and class 2 (74.5%) patients. Cesarean section was the mode of delivery for 87% of pregnancies at < 30 weeks' gestation in contrast to 68% of pregnancies at > or = 30 weeks but < 34 weeks' gestation (odds ratio 3.2, 95% confidence interval 1.4 to 7.5, p < 0.005). Indications for cesarean section included deteriorating maternal condition alone (50%), deteriorating maternal and fetal condition (27%), nonvertex fetal presentation (11.5%), and failure to progress (11%). Induction of labor was significantly more successful during the > or = 30 but < 34 weeks' pregnancy interval (47.5%) than in pregnancies at < 30 weeks (15.2%) (odds ratio 0.2, 95% confidence interval 0.1 to 0.55, p < 0.001). A trial of labor was successful in 22% of patients with an initial modified Bishop score < or = 2 versus 45% with an initial Bishop > 2 (odds ratio 0.5, 95% confidence interval 0.2 to 1.3, p = 0.16).
Parturients with class 1 and 2 HELLP syndrome at < 34 weeks' gestation are at high risk for cesarean delivery. At a gestational age < 30 weeks, the likelihood of successful labor induction with vaginal delivery is remote, especially in association with an unfavorable cervix or the absence of labor.
我们的目的是研究妊娠小于34周并合并溶血、肝酶升高及血小板减少综合征（HELLP）的患者与分娩方式相关的因素。
回顾性研究了1980年1月至1991年10月间189例患有HELLP综合征且妊娠小于34周并分娩的患者。仅纳入1级（血小板最低点≤50,000/微升，n = 83）和2级（血小板最低点>50,000至≤100,000/微升，n = 106）HELLP综合征患者。回顾了与分娩类型相关的母体和围产期因素。
所有患者剖宫产发生率为76.2%（初次剖宫产率72.4%）。1级（78.3%）和2级（74.5%）患者的剖宫产发生率相当。妊娠小于30周时，87%的妊娠采用剖宫产分娩，而妊娠≥30周但小于34周时这一比例为68%（优势比3.2，95%置信区间1.4至7.5，p<0.005）。剖宫产指征包括单纯母体状况恶化（50%）、母体和胎儿状况均恶化（27%）、胎位异常（11.5%）及产程无进展（11%）。妊娠≥30周但小于34周期间引产成功率（47.5%）显著高于妊娠小于30周时（15.2%）（优势比0.2，95%置信区间0.1至0.55，p<0.001）。初始改良Bishop评分≤2的患者引产成功率为22%，而初始Bishop评分>2的患者引产成功率为45%（优势比0.5，95%置信区间0.2至1.3，p = 0.16）。
妊娠小于34周的1级和2级HELLP综合征产妇剖宫产风险高。妊娠小于30周时，经阴道成功引产的可能性很小，尤其是在宫颈条件不佳或未发动宫缩的情况下。
