Placental abruption in each hypertensive disorders of pregnancy phenotype: a retrospective cohort study using a national inpatient database in Japan
Placental abruption in each hypertensive disorders of pregnancy phenotype: a retrospective cohort study using a national inpatient database in Japan
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每种妊娠高血压疾病表型中的胎盘早剥：利用日本国家住院患者数据库进行的回顾性队列研究
DOI：
10.1038/s41440-020-00537-6
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发表时间：
2020
影响因子：
5.4
通讯作者：
Arai Takanari
中科院分区：
文献类型：
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作者：
Naruse Katsuhiko;for the Advanced Life Support in Obstetrics (ALSO)-Japan Research Group;Shigemi Daisuke;Hashiguchi Mikio;Imamura Masatoshi;Yasunaga Hideo;Arai Takanari
我们设计了一项回顾性队列研究，使用诊断程序组合数据库，一个日本急性护理住院患者的国家住院数据库，以检查最近的全球先兆子痫诊断标准，妊娠高血压疾病（HDP）的表型和疾病的特征是否可作为胎盘脱垂的预测因子，以及其他危险因素是否与胎盘脱垂的发生相关。本研究共纳入了85，858例诊断为HDP的住院患者，这些患者在2010年7月至2018年3月期间住院分娩。我们采用多因素logistic回归分析，研究了住院后胎盘脱垂的发生与几个因素之间的关系，包括胎盘脱垂发生时的胎龄（GA）、HDP亚型、入院时的GA、母亲年龄、体重指数、吸烟、多胎妊娠、产前胎膜破裂、糖尿病、救护车紧急入院和意识。541例（0.63%）患者入院后发生胎盘脱垂，GA 32周后发生率急剧增加。妊娠率降低与母亲入院时BMI（≥30 kg/m2;比值比[OR]，0.54; 95%置信区间[CI]，0.41-0.70）和多胎妊娠（OR，0.29; 95% CI，0.18-0.46）显著相关。入院时GA较早（<34周GA; OR，3.77; 95% CI，3.13-4.53）和救护车紧急入院（OR，1.34; 95% CI，1.09-1.65）与预防性增加相关。重度肺栓塞的个体特征与肺栓塞的发生无显著相关性。总之，在早期GA的HDP被认为是一个危险因素，胎盘脱垂，我们建议住院治疗和谨慎的管理，这样的患者，以改善其预后。
We designed a retrospective cohort study using the Diagnosis Procedure Combination database, a national inpatient database for acute-care inpatients in Japan, to examine whether recent global diagnostic criteria for preeclampsia, phenotypes of hypertensive disorders of pregnancy (HDP) and features of the disease are useful as predictors of placental abruption and whether other risk factors are associated with the onset of placental abruption. A total of 85,858 hospitalized patients with a diagnosis of HDP who gave birth during hospitalization between July 2010 and March 2018 were included in this study. We examined the associations between the occurrence of placental abruption after hospitalization and several factors, including gestational age (GA) at placental abruption onset, HDP subtypes, GA on admission, maternal age, body mass index, smoking, multiple pregnancy, prelabor rupture of membranes, diabetes mellitus, emergency admission by ambulance, and consciousness, using a multivariate logistic regression analysis. Placental abruption occurred in 541 patients (0.63%) after hospital admission, and the occurrence increased acutely after 32 weeks GA. A decrease in abruption was significantly associated with maternal BMI on admission (≥30 kg/m2; odds ratio [OR], 0.54; 95% confidence interval [CI], 0.41–0.70) and multiple pregnancy (OR, 0.29; 95% CI, 0.18–0.46). An increase in abruption was associated with earlier GA on admission (<34 weeks’ GA; OR, 3.77; 95% CI, 3.13–4.53) and emergency admission by ambulance (OR, 1.34; 95% CI, 1.09–1.65). Individual features of severe PE showed no significant associations with the occurrence of abruption. In conclusion, HDP at an earlier GA was suggested to be a risk factor for placental abruption, and we recommend hospitalization and careful management of such patients to improve their prognosis.