Health Outcomes Associated With Clinician-initiated Delivery for Hypertensive Disorders at 34-38 Weeks' Gestation.
Health Outcomes Associated With Clinician-initiated Delivery for Hypertensive Disorders at 34-38 Weeks' Gestation.
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DOI：
10.1097/ede.0000000000001442
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发表时间：
2022-03-01
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影响因子：
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通讯作者：
Gutmann R
中科院分区：
文献类型：
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作者：
Savitz DA;Danilack VA;Cochancela J;Hughes BL;Rouse DJ;Gutmann R
在美国，近10%的妊娠晚期非严重高血压疾病患者的临床医生需要更好的证据来平衡临床医生主动分娩的风险和好处。我们在罗德岛妇婴医院对2002-2013年分娩的产妇和婴儿的健康结果进行了一项基于记录的队列研究。受试者在妊娠39周前有妊娠期高血压或非重度子痫前期(N=4295)。对于从34周到38周的每一孕周，我们比较了临床医生发起的分娩(引产或产前剖腹产)和未在该周开始的分娩之间的结果，使用倾向评分模型来控制指征的混淆。分析预测，如果所有患者都接受临床医生发起的分娩，母婴结局不良的风险将持续到第37周，产妇结局的风险差异约为0.2，婴儿结局的风险差异约为0.3。对于接受临床医生发起分娩的妇女，分析发现在第35周和36周进展为严重疾病的风险增加，所有不良婴儿结局仅在第34周增加，在第35周和36周NICU入院和婴儿住院时间增加，在第37周或38周没有任何不良后果的显著增加。我们估计，选择进行干预的高血压孕妇在怀孕34周后早产的伤害最小，但预计延长到37周会有好处。我们的研究还显示了与37周前常规分娩相关的不良婴儿健康后果。
Clinicians caring for the nearly 10% of patients in the United States with non-severe hypertensive disorders in late pregnancy need better evidence to balance risks and benefits of clinician-initiated delivery. We conducted a record-based cohort study of maternal and infant health outcomes among deliveries from 2002–2013 at Women & Infants Hospital of Rhode Island. Participants had gestational hypertension or non-severe preeclampsia before 39 weeks’ gestation (N=4,295). For each gestational week from 34 to 38, we compared outcomes between clinician-initiated deliveries (induction of labor or prelabor cesarean) and those not initiated in that week, using propensity score models to control confounding by indication. The analysis predicted an increment in risk of adverse maternal and infant outcomes sustained through week 37 if all patients underwent clinician-initiated delivery, with risk differences on the order of 0.2 for maternal outcomes and 0.3 for infant outcomes weeks 34 and 35. For women undergoing clinician-initiated delivery, the analysis identified increased risk of progression to severe disease in weeks 35 and 36, increases in all adverse infant outcomes only in week 34, increases in NICU admission and infant hospital stay in weeks 35 and 36, and no meaningful increase in any of the adverse outcomes in weeks 37 or 38. We estimate that hypertensive pregnancies chosen for intervention were minimally harmed by early delivery after 34 weeks’ gestation but predict benefit from extension to 37 weeks. Our study also showed adverse infant health consequences associated with routine delivery prior to 37 weeks.