The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age
The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age
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DOI：
10.1016/j.ajog.2015.02.012
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发表时间：
2015-05-01
影响因子：
9.8
通讯作者：
Caughey, Aaron B.
中科院分区：
文献类型：
--
作者：
Puljic, Anela;Kim, Elissa;Caughey, Aaron B.
目的：本研究的目的是通过对合并胆汁淤积的孕妇每增加一周的期待治疗与立即分娩来描述婴儿和胎儿死亡的风险。这是一项对1，604，386例单胎患者进行的回顾性队列研究，妊娠34 - 40周的非异常妊娠，伴或不伴妊娠肝内胆汁淤积症（ICP）在2005-2008年期间在加州州。使用了国际疾病分类第9版、编码以及相关的出院和生命统计数据。对于妊娠的每一周，评估以下结局：死产风险、分娩风险（以妊娠特定周的婴儿死亡风险表示）和额外1周期待治疗的复合风险。综合风险结合了在此胎龄周死产的风险加上婴儿死亡的风险，如果交付在随后的week of gestation.RESULTS：在ICP的妇女，分娩的死亡风险低于期待管理的风险在36周的妊娠（4.7比19.2每10,000）。期待治疗的风险仍然高于分娩，并在妊娠36周后继续增加。ICP妇女期待治疗的风险在35周时达到最低点（9.1/10，000; 95%置信区间，1.4e16.9），并在36周时升高（19.2/10，000; 95%置信区间，7.6-30.8）。在ICP患者中，与期待治疗相比，孕36周分娩可降低围生儿死亡风险。对于以后的诊断，这也将是真实的胎龄超过36周。分娩时机必须考虑到死产风险的降低与早产相关的发病率的平衡。
OBJECTIVE: The objective of the study was to characterize the risk of infant and fetal death by each additional week of expectant management vs immediate delivery in pregnancies complicated by cholestasis.STUDY DESIGN: This was a retrospective cohort study of 1,604,386 singleton, nonanomalous pregnancies of women between 34 and 40 weeks' gestation with and without intrahepatic cholestasis of pregnancy (ICP) in the state of California during the years of 2005-2008. International Classification of Diseases, 9th version, codes and linked hospital discharge and vital statistics data were utilized. For each week of gestation, the following outcomes were assessed: the risk of stillbirth, the risk of delivery (represented by the risk of infant death at a given week of gestation), and the composite risk of expectant management for 1 additional week. Composite risk combines the risk of stillbirth at this gestational age week plus the risk of infant death if delivered at the subsequent week of gestation.RESULTS: Among women with ICP, the mortality risk of delivery is lower than the risk of expectant management at 36 weeks' gestation (4.7 vs 19.2 per 10,000). The risk of expectant management remains higher than delivery and continues to rise by week of gestation beyond 36 weeks. The risk of expectant management in women with ICP reaches a nadir at 35 weeks (9.1 per 10,000; 95% confidence interval, 1.4e16.9) and rises at 36 weeks (19.2 per 10,000; 95% confidence interval, 7.6-30.8).CONCLUSION: Among women with ICP, delivery at 36 weeks' gestation would reduce the perinatal mortality risk as compared with expectant management. For later diagnoses, this would also be true at gestational ages beyond 36 weeks. Timing of delivery must take into account both the reduction in stillbirth risk balanced with the morbidities associated with preterm delivery.