Expectant management of severe preeclampsia at less than 27 weeks' gestation: maternal and perinatal outcomes according to gestational age by weeks at onset of expectant management
Expectant management of severe preeclampsia at less than 27 weeks' gestation: maternal and perinatal outcomes according to gestational age by weeks at onset of expectant management
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DOI：
10.1016/j.ajog.2008.06.086
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发表时间：
2008-09-01
影响因子：
9.8
通讯作者：
Sibai, Baha M.
中科院分区：
文献类型：
--
作者：
Bombrys, Annette E.;Barton, John R.;Sibai, Baha M.
目的：该研究的目的是确定围产期结局和产妇发病率的基础上胎龄（GA）在开始的预期管理在严重子痫前期小于27周。研究设计：这是一项对严重子痫前期患者预后的回顾性分析。研究了46例（51例胎儿）小于27周的严重先兆子痫。皮质类固醇治疗超过23周。分析围产期和产妇并发症（包括HELLP（溶血、肝酶升高和低血小板计数）综合征、肺水肿、子痫和肾功能不全等综合产妇发病率）。结果：4例患者有多胎妊娠（1例三胞胎，3例双胞胎）。延长的中位天数为6天（范围2-46天）。总围产期生存率为29 / 51（57%）。27例（53%）出生体重低于10%，18例（35%）出生体重低于5%。在GA小于23周的患者中，没有围产期幸存者，在23至23 6/7周时，10例中有2例（20%）存活，并且均达到分娩时的26周。24 ~ 24 6/7周、25 ~ 25 6/7周和26 ~ 26 6/7周的围产儿存活率分别为5 /7（71%）、13 / 17（76%）和9 / 10 (90%)；但呼吸系统并发症的发生率很高。没有产妇死亡，但总体产妇发病率为46例中有21例（46%），但在24周以下的产妇中，14例中有9例（64%）。结论：妊娠中期重度子痫前期围产儿结局依赖于期待性用药时的GA和分娩时的GA。考虑到24周以下孕妇的高发病率和极低的围产期存活率，应在广泛咨询后提供终止妊娠。
OBJECTIVE: The objective of the study was to determine perinatal outcome and maternal morbidities based on gestational age (GA) at the onset of expectant management in severe preeclampsia at less than 27 weeks. STUDY DESIGN: This was a retrospective analysis of outcome in patients with severe preeclampsia. Forty-six patients (51 fetuses) with severe preeclampsia at less than 27 weeks were studied. Corticosteroids were administered beyond 23 weeks. Perinatal and maternal complications (a composite maternal morbidities including HELLP ( hemolysis, elevated liver enzymes, and low platelet count) syndrome, pulmonary edema, eclampsia, and renal insufficiency were analyzed. RESULTS: Four patients had multifetal gestations (1 triplet, 3 twins). Median days of prolongation was 6 (range 2-46). Overall perinatal survival was 29 of 51 (57%). Birthweights of 27 (53%) were less than 10%, and 18 (35%) were less than 5%. There were no perinatal survivors in those with a GA less than 23 weeks, at 23 to 23 6/7 weeks, 2 of 10 (20%) survived, and both reached 26 weeks at delivery. For those at 24 to 24 6/7, 25 to 25 6/7, and 26 to 26 6/7 weeks, the perinatal survival rates were 5 of 7 (71%), 13 of 17 (76%), and 9 of 10 (90%), respectively; but rates of respiratory complications were high. There were no maternal deaths, but overall maternal morbidity was 21 of 46 (46%), but was 9 of 14 (64%) in those at less than 24 weeks. CONCLUSION: Perinatal outcome in severe preeclampsia in the midtrimester is dependent on GA at onset of expectant management and GA at delivery. Given the high maternal morbidity and extremely low perinatal survival in expectant management at less than 24 weeks, termination of pregnancies should be offered after extensive counseling.