Piper J M, Langer O, Xenakis E M, McFarland M, Elliott B D, Berkus M D
Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, USA.
Obstet Gynecol. 1996 Aug;88(2):194-9. doi: 10.1016/0029-7844(96)02169-2.
To test the hypothesis that fetal growth restriction (FGR) associated with a maternal hypertensive disorder results in worse perinatal outcome than FGR in pregnancies without maternal hypertension.
All consecutive, singleton, nondiabetic, small for gestational age (SGA) deliveries (birth weight at or below the tenth percentile for gestational age) in a 15-year computerized data base were analyzed for pregnancy outcome. Perinatal outcome was compared after stratification by presence or absence of hypertensive disorders and by gestational age at delivery.
Eleven thousand two hundred twenty-seven SGA pregnancies were analyzed. The morbidity and mortality profiles differed between hypertensive and normotensive pregnancies delivered preterm and those delivered at term. Perinatal mortality was significantly higher in the normotensive than in the hypertensive group in preterm deliveries (30.3 versus 18.7%, odds ratio [OR] 1.9 [confidence interval (CI) 1.3-2.9]). At term, hypertensive pregnancies demonstrated significantly higher mortality than normotensive pregnancies (4.6 versus 1.9%, OR 2.42 [95% CI 1.7-3.4]). In both preterm and term gestations, cesarean rates were significantly higher in hypertensive pregnancies than in normotensive pregnancies. Using logistic regression analysis, hypertension was independently associated with a 39% reduction in risk of perinatal mortality preterm, compared with a twofold increased risk of perinatal mortality at term.
Before term, FGR in normotensive women resulted in significantly higher perinatal mortality than FGR in hypertensive women. In contrast, at term, FGR in pregnancies complicated by hypertension had poorer perinatal outcomes than FGR in normotensive women.
验证与母体高血压疾病相关的胎儿生长受限（FGR）相比无母体高血压的妊娠中的FGR会导致更差围产期结局这一假设。
分析一个15年计算机数据库中所有连续、单胎、非糖尿病、小于胎龄（SGA）分娩（出生体重处于或低于胎龄第十百分位数）的妊娠结局。根据是否存在高血压疾病以及分娩时的孕周进行分层后比较围产期结局。
分析了11227例SGA妊娠。早产的高血压和血压正常妊娠以及足月分娩的此类妊娠的发病率和死亡率情况有所不同。早产时，血压正常组的围产期死亡率显著高于高血压组（30.3%对18.7%，优势比[OR]1.9[置信区间（CI）1.3 - 2.9]）。足月时，高血压妊娠的死亡率显著高于血压正常妊娠（4.6%对1.9%，OR 2.42[95%CI 1.7 - 3.4]）。在早产和足月妊娠中，高血压妊娠的剖宫产率均显著高于血压正常妊娠。使用逻辑回归分析，与足月时围产期死亡风险增加两倍相比，高血压与早产时围产期死亡风险降低39%独立相关。
在足月前，血压正常女性的FGR导致的围产期死亡率显著高于高血压女性的FGR。相比之下，足月时，合并高血压的妊娠中的FGR比血压正常女性的FGR围产期结局更差。
