Nassar A H, Adra A M, Chakhtoura N, Gómez-Marín O, Beydoun S
Division of Perinatology, Department of Obstetrics and Gynecology, University of Miami School of Medicine, Miami, FL 33101, USA.
Am J Obstet Gynecol. 1998 Nov;179(5):1210-3. doi: 10.1016/s0002-9378(98)70133-4.
The study's objectives were as follows: (1) to determine the rate of vaginal delivery after labor induction in severe preeclampsia remote from term and (2) to determine potential predictors of success.
Retrospective chart review was conducted on live-born singleton pregnancies complicated by severe preeclampsia and delivered at 24 to 34 weeks' gestation from January 1, 1992, to December 31, 1996. Exclusion criteria included eclampsia, presence of labor or spontaneous rupture of membranes on admission, and complication of pregnancy by an ultrasonographically detected fetal congenital anomaly. Patients were divided into 3 groups: elective cesarean delivery without labor, cesarean delivery after labor induction, and vaginal delivery after labor induction. Statistical analyses included multiple logistic regression, the Student t test, the chi2 test, and the Mann-Whitney test. P </=.05 was considered significant.
A total of 306 charts were reviewed. Among these, 161 patients (52.6%) underwent elective cesarean delivery without labor; the 2 most common indications were unfavorable cervix (33.5%) and malpresentation (22.4%). The remaining 145 patients (47.4%) underwent labor induction with a 48. 3% rate of vaginal delivery after induction, ranging from 31.6% at </=28 weeks' gestation to 62.5% at >32 weeks' gestation. The most common indication for cesarean delivery after induction, in 50.7% of the cases, was nonreassuring fetal heart rate. The median Bishop score was significantly higher (3 vs 2, P =.004) and the total hospital stay was significantly shorter in the vaginal delivery after induction group than in the cesarean delivery after induction group. However, there were no significant differences between the 2 groups in use of cervical ripening agents, gestational age at delivery, birth weight, 5-minute Apgar score, or postpartum endometritis. After exclusion of cesarean deliveries performed for malpresentation, there was no statistically significant difference in classic incision rates between the elective cesarean delivery without labor and cesarean delivery after induction groups (13.6% vs 6.8%; P =.137). According to logistic regression analysis, only the Bishop score was significantly associated with a successful induction (odds ratio 1.38, 95% confidence interval 1.11-1.71). Gestational age reached marginal significance (odds ratio 1.30, 95% confidence interval 0.89-1.89).
(1) Labor induction should be considered a reasonable option for patients with severe preeclampsia at </=34 weeks' gestation because 48% of patients given the chance were successfully delivered vaginally. (2) The Bishop score on admission is the best predictor of success, although the chance of successful labor induction increases with advancing gestational age.
本研究的目的如下：（1）确定孕周尚远的重度子痫前期患者引产术后的阴道分娩率；（2）确定成功引产的潜在预测因素。
对1992年1月1日至1996年12月31日期间孕周为24至34周、因重度子痫前期而分娩的单胎活产妊娠病例进行回顾性图表分析。排除标准包括子痫、入院时已临产或胎膜早破，以及超声检查发现胎儿先天性异常的妊娠并发症。患者分为3组：未临产即行选择性剖宫产、引产术后剖宫产、引产术后阴道分娩。统计分析包括多因素logistic回归、Student t检验、chi2检验和Mann-Whitney检验。P≤0.05被认为具有统计学意义。
共查阅了306份病历。其中，161例患者（52.6%）未临产即行选择性剖宫产；最常见的两个指征是宫颈条件不佳（33.5%）和胎位异常（22.4%）。其余145例患者（47.4%）接受了引产，引产术后阴道分娩率为48.3%，孕周≤28周时为31.6%，>32周时为62.5%。引产术后剖宫产最常见的指征（50.7%的病例）是胎儿心率异常。引产术后阴道分娩组的中位Bishop评分显著更高（3分对2分，P = 0.004），且总住院时间显著短于引产术后剖宫产组。然而，两组在使用宫颈成熟剂、分娩时的孕周、出生体重、5分钟Apgar评分或产后子宫内膜炎方面无显著差异。排除因胎位异常而进行的剖宫产术后，未临产即行选择性剖宫产组与引产术后剖宫产组的古典式切口率无统计学显著差异（13.6%对6.8%；P = 0.137）。根据logistic回归分析，只有Bishop评分与引产成功显著相关（优势比1.38，95%置信区间1.11 - 1.71）。孕周达到边缘显著性（优势比1.30，95%置信区间0.89 - 1.89）。
（1）对于孕周≤34周的重度子痫前期患者，引产应被视为一种合理选择，因为48%有机会的患者成功经阴道分娩。（2）入院时的Bishop评分是成功引产的最佳预测因素，尽管随着孕周增加，引产成功的机会也会增加。
