Maternal-fetal conditions necessitating a medical intervention resulting in preterm birth
Maternal-fetal conditions necessitating a medical intervention resulting in preterm birth
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DOI：
10.1016/j.ajog.2006.05.021
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发表时间：
2006-12-01
影响因子：
9.8
通讯作者：
Vintzileos, Anthony M.
中科院分区：
文献类型：
--
作者：
Ananth, Cande V.;Vintzileos, Anthony M.
目的：本研究的目的是评估孕产妇和胎儿状况在多大程度上需要医学上指示的早产。研究设计：对 1989 年至 1997 年密苏里州 20 周或更长时间单胎活产的妇女进行了一项基于人群的回顾性队列研究 (11 684 71 1)。导致医源性早产的母婴疾病包括先兆子痫、小于胎龄儿、胎儿窘迫、胎盘早剥、前置胎盘、不明原因阴道出血、孕前和妊娠期糖尿病、肾脏疾病、Rh 过敏和先天性畸形。我们检查了上述每种情况与医学上指示的早产风险之间的关联（小于 35 周）。有医学指征的早产被定义为早产时没有胎膜早破的情况下的引产或产前剖宫产。根据多变量逻辑回归模型得出调整后的早产相对风险（95% 置信区间），并计算人口归因分数。结果：早产率（小于 35 周）为 4.6% (n = 31,238)，其中 23.5% (n = 7,347) 的此类分娩有医学指征。先兆子痫、胎儿窘迫、小于胎龄和胎盘早剥是导致早产的医疗干预的最常见指征，53.2% 的有医学指征的早产和 17.7% 的足月产中至少存在其中一种情况（相对风险 4.9，95% 置信区间 4.7、5.2）。结论：先兆子痫、胎儿窘迫、超过一半的有医学指征的早产与小于胎龄和胎盘早剥等与缺血性胎盘疾病相关的疾病有关。尽管早产的病因多种多样，但缺血性胎盘疾病可能是早产的重要途径是合理的。 (c) 2006 Mosby, Inc. 保留所有权利。
Objective: The objective of the study was to evaluate the extent to which maternal and fetal conditions necessitate medically indicated preterm birth.Study design: A population-based, retrospective, cohort study of women who delivered a singleton live birth at 20 weeks or longer in Missouri, 1989 to 1997 was performed (11 684 71 1). Maternal-fetal conditions that necessitated iatrogenic preterm birth included preeclampsia, small-for-gestational-age birth, fetal distress, placental abruption, placenta previa, unexplained vaginal bleeding, pregestational and gestational diabetes, renal disease, Rh sensitization, and congenital malformations. We examined the association between each of the aforementioned conditions and risk of medically indicated preterm birth Lit less than 35 weeks. Medically indicated preterm birth was defined as a labor induction or a prelabor cesarean in the absence of premature rupture of membranes at preterm gestations. Adjusted relative risk with 95% confidence interval for preterm birth was derived from niultivariable logistic regression models, and Population attributable fractions were Calculated.Results: The preterm birth rate (less than 35 weeks) was 4.6% (n = 31,238), with 23.5% (n 7,347) of such births being medically indicated. Preeclampsia, fetal distress, small-for-gestational-age, and placental abruption were the most common indications for a medical intervention resulting in preterm birth, with at least I of these conditions present in 53.2% of medically indicated preterm births and in 17.7% of term births (relative risk 4.9, 95% confidence interval 4.7, 5.2).Conclusion: Preeclampsia, fetal distress, small-for-gestational-age, and placental abruption, conditions that are associated with ischemic placental disease, are implicated in well over half of all medically indicated preterm births. Although the etiology of preterm birth is heterogeneous, it is reasonable that ischemic placental disease may serve as an important pathway to preterm birth. (c) 2006 Mosby, Inc. All rights reserved.