Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced?
Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced?
复制标题
DOI：
10.3109/14767050903168432
复制
发表时间：
2010-05-01
影响因子：
1.8
通讯作者：
Caughey, Aaron B.
中科院分区：
文献类型：
--
作者：
Kim, Lena Heesun;Cheng, Yvonne W.;Caughey, Aaron B.
方法：研究方法。这项对3505名怀孕24周的单胎孕妇进行引产的回顾性队列研究比较了先兆子痫患者和非先兆子痫患者的剖宫产率。使用多因素Logistic回归分析控制潜在的混杂因素，包括宫颈不良(Bishop评分)、引产方法、母亲年龄、产次、胎龄、种族/民族、硬膜外用药、医疗保险和婚姻状况。在足月未经产妇中，先兆子痫组的剖宫产率高于非先兆子痫组(81/267，30%比363/1568，23%；p=0.011)，先兆子痫组与足月经产妇相比(10/，16%比55/900，6%，p=0.003)有更高的剖宫产率。在未产妇(48/164vs.16/245vs.16/245vs.7%；p<；0.001)和经产期妇女(13/72，18%vs.18/225vs.18/225vs.8%；p=0.015)中，早产先兆子痫患者的剖宫产率也高于非先兆子痫患者。在多变量分析中，如果引产，先兆子痫仍会增加剖宫产的风险(调整后的优势比=1.90，95%可信区间为1.45~2.48)。与非先兆子痫患者相比，接受引产的先兆子痫患者的剖宫产率更高，无论胎次或胎龄。然而，大多数患有先兆子痫的妇女仍然有成功的阴道分娩。
Methods. This retrospective cohort study of 3505 women >= 24 weeks gestation with singleton pregnancies undergoing labor induction compares cesarean delivery rates between preeclamptics and non-preeclamptics. Multivariable logistic regression analysis was used to control for potential confounders including unfavorable cervix (Bishop score < 5), method of labor induction, maternal age, parity, gestational age, race/ethnicity, epidural use, medical insurance, and marital status.Results. Among term nulliparous women undergoing labor induction, preeclamptics had a higher cesarean delivery rate then non-preeclamptics (81/267, 30% vs. 363/1568, 23%; p = 0.011), as did preeclamptic compared with non-preeclamptic women who were term and multiparous (10/64, 16% vs. 55/900, 6%, p = 0.003). Preterm preeclamptics also had more cesarean deliveries compared with non-preeclamptics among nulliparous (48/164, 29% vs. 16/245, 7%; p < 0.001) and multiparous (13/72, 18% vs. 18/225, 8%; p = 0.015) women. In multivariable analysis, preeclampsia still conferred an increased risk of cesarean delivery if labor was induced (adjusted odd ratio = 1.90, 95% CI 1.45-2.48).Conclusion. Women with preeclampsia undergoing labor induction had higher cesarean delivery rates compared with non-preeclamptics regardless of parity or gestational age. However, the majority of women with preeclampsia still had successful vaginal deliveries.