再发子痫前期危险因素分析

目的探讨子痫前期复发的相关危险因素。方法对2015年9月至2017年3月在湖南省妇幼保健院住院的有两次单胎妊娠且前次妊娠为子痫前期的112例患者的临床资料进行回顾性分析,根据第二次妊娠是否为子痫前期分为两组,再发子痫前期组(72例)和对照组(40例),采用单因素分析及二项分类logistic回归分析各因素与子痫前期复发之间的关系。结果①再发子痫前期组与对照组前次妊娠合并胎儿生长受限(fetal growth restriction, FGR)、两次妊娠时间间隔、再次妊娠年龄、再次妊娠孕前体质指数(BMI),妊娠期有无规律产前检查比较,差异均有统计学意义(P 0.05);②再次妊娠年龄(OR=3.394,95%CI:1.250～9.214,P=0.016)、再次妊娠孕前BMI(OR=4.809,95%CI:1.686～13.712,P=0.003)及两次妊娠间隔时间(OR=3.912,95%CI:1.425～10.739,P=0.008)是再发子痫前期的独立危险因素。结论再次妊娠年龄、再次妊娠孕前BMI和两次妊娠间隔时间是预测子痫前期复发的主要危险因素。     

妊娠期不同时段鼾症与子痫前期发病的相关性研究

目的探讨妊娠期不同时段鼾症的发生情况及其与子痫前期发病的关系。方法对2015年3月至2015年8月北京大学人民医院产前检查并住院分娩的462例妇女进行问卷调查,随访母体结局,比较鼾症组和非鼾症组子痫前期发病的差异;多因素logistic回归分析子痫前期发病的危险因素。结果 1妊娠前、早、中、晚期鼾症的发病率分别为5.41%(25/462)、5.63%(26/462)、20.13%(93/462)和24.46%(113/349),各阶段发病率比较,差异有统计学意义(P0.05)。2在妊娠各时段,鼾症组子痫前期的发病率均显著高于非鼾症组(P0.05)。3多因素回归分析显示,年龄(≥35岁)、孕前BMI(≥30 kg/m2)及妊娠中期打鼾是子痫前期发病的独立危险因素,比值比(OR)分别为1.30(95%CI:1.13~1.49,P=0.000)、1.26(95%CI:1.11~1.44,P=0.001)和4.95(95%CI:1.80~13.65,P=0.002)。结论随着妊娠的进展,鼾症的发生呈上升趋势;鼾症组子痫前期的发病率显著升高;妊娠中期鼾症是子痫前期发病的独立危险因素,应重视鼾症孕妇的围生期保健。     

西藏林芝地区胎儿先天性心脏病的危险因素分析

目的:探究西藏林芝地区先天性心脏病(CHD)的发生情况及其相关危险因素的关系。方法:选择于2016年6月至2018年6月在林芝市人民医院产前检查和(或)分娩且为当地常住人口的2126例孕妇,孕中期常规进行胎儿CHD筛查及孕期危险因素的调查。经胎儿超声心动图诊断出胎儿心脏畸形病例纳入CHD组,将胎儿超声心动图检查结果正常的孕妇纳入对照组,所有胎儿出生后进一步检查以明确诊断。结果:CHD组纳入26例,产后均确诊为CHD;对照组纳入2100例,产后进行一般体检未见异常,心脏听诊未闻及杂音;CHD产前检出率1.22%。单因素分析结果显示,两组孕妇年龄、孕前体质量指数(BMI)、孕产史、孕前6个月至此次产前检查期间主动及被动吸烟史、孕早期补充叶酸及微量元素、孕期发热史及感染性疾病史、妊娠期合并糖尿病史比较,差异有统计学意义(P0.05)。多因素分析结果显示,孕前超重(OR=13.60,95%CI 5.04～36.66)及孕前肥胖(OR=67.33,95%CI 16.03～282.78)、孕前6个月至此次产前检查期间主动与被动吸烟史(OR=4.02,95%CI 1.59～10.17)、孕期发热史(OR=10.31,95%CI 1.56～68.29)、妊娠合并糖尿病史(OR=15.88,95%CI 3.90～64.63)是胎儿发生CHD的危险因素。结论:为降低先心病的发病及改善预后,应加强林芝地区孕妇的孕期保健知识宣教及孕期管理,及时进行有效产前检查。     

轻中度慢性高血压孕期血压维持和控制水平对母儿结局影响研究

目的 探讨妊娠期轻中度慢性高血压患者孕期血压维持和控制水平对母儿结局的影响。方法 对2012年1月至2016年12月5年间在北京大学第三医院接受规律产前检查并结束妊娠且资料完整的初始诊断为妊娠合并慢性高血压的302例临床观察资料进行分析,比较孕期血压(blood pressure,BP)维持和控制的不同水平组(A组血压130/80mm Hg、B组130~139/80~89mm Hg、C组140~149/90~99mm Hg、D组150~159/100~109mm Hg)的临床特征及重度高血压(sever hypertension)、伴蛋白尿的子痫前期(preeclampsia with proteinuria,PE-Pro)、重度子痫前期(sever preeclampsia,SPE)以及小于胎龄儿(small-For-gestational-age,SGA)的发生率。结果 慢性高血压血压分级影响分析:孕前或孕早期慢性高血压Ⅲ级患者在孕中期或孕晚期重度高血压和SPE的发生率比高血压Ⅰ级者高(P0.05),但对PE-Pro、SGA的发生率未见影响(P0.05)。孕前或孕早期慢性高血压Ⅲ级患者发生PE-Pro、SPE的孕周比高血压Ⅰ级者早(P0.05),但对重度高血压的发病孕周未见影响(P0.05)。孕期血压维持和控制水平分析:A组重度高血压、PE-Pro、SPE的发生率比B组低(P0.05),B组重度高血压的发生率比C组低(P0.05)。孕期血压维持和控制水平对SGA的发生率未见影响(P0.05)。多因素分析显示血压维持和控制水平影响重度高血压、PE-Pro、SPE的发生(OR=4.957,95%CI 1.409~17.443;OR=2.388,95%CI 1.446~3.944;OR=1.174,95%CI 1.666~6.047);孕前或孕早期出现蛋白尿(OR=17.693 95%CI 1.800~173.886)是SPE的独立影响因素。肥胖是SGA的保护因素(OR=0.099,95%CI 0.013~0.737),孕期体重增长、血压维持和控制水平是SGA的独立影响因素(OR=0.803,95%CI 0.657~0.982;OR=5.786,95%CI 1.542~1.703)。结论 慢性高血压轻中度孕妇孕期血压控制有利于降低重度高血压、子痫前期、重度子痫前期的发生,而且并不对SGA的发生造成影响。     

妊娠合并系统性红斑狼疮患者孕期病情活动的影响因素及其与妊娠结局的关系

目的 探讨妊娠合并系统性红斑狼疮（SLE）患者孕期病情活动的影响因素及其与妊娠结局的关系.方法 对1991年至2005年收治的66例妊娠合并SLE患者的临床资料进行回顾性分析.结果 （1）孕前病情不稳定、孕期新发病及孕期泼尼松用药不规范者均出现SLE病情活动;孕期S比病情活动者32例（活动组）,非活动者34例（非活动组）.（2）活动组患者发生子痫前期9例、胎儿生长受限（FGR）13例、治疗性流产7例和早产15例,非活动组分别为1例、5例、1例和4例,两组分别比较,差异有统计学意义（P均＜0.05）.（3）活动组患者不同器官损伤中,以肾损害对妊娠的影响最大;用logistic回归前进法筛选变量结果显示,肾损害是子痫前期、FGR的独立危险因素.（4）孕期泼尼松用量每天≤15 mg者子痫前期及胎儿丢失发生率分别为4.7%（2/43）及9.3%（4/43）,用量每天≥20 mg者的子痫前期及胎儿丢失发生率分别为33.3%（6/18）及44.4%（8/18）,两者比较,差异有统计学意义（P＜0.01）.结论 孕前SLE比病情不稳定、孕期新发病及孕期泼尼松用药不规范为SLE病情活动的重要影响因素.孕期SLE病情活动特别是肾损害与不良妊娠结局有密切关系.孕期泼尼松用量每天≥20 mg者发生子痫前期及胎儿丢失的几率大于每天≤15 mg者.     

子痫前期严重并发症的危险因素分析

目的探讨子痫前期患者发生严重并发症的危险因素。 方法回顾性分析805例子痫前期患者及其围产儿临床资料,将发生严重并发症的327例患者作为研究组,478例未发生严重并发症患者作为对照组。 结果(1)子痫前期严重并发症发生率为40.6%(327/805例),327例患者的严重并发症包括138例死胎(42.2%)、71例HELLP综合征(21.7%)、65例胎盘早剥(19.9%)、39例心功能衰竭(11.9%)、39例产后出血(11.9%)、36例肺水肿(11.0%)等。(2)两组患者临床表现进行的比较,发病孕周、收缩压、舒张压、血肌酐、丙氨酸转氨酶、血清白蛋白和期待治疗时间,差异具有统计学意义(P<0.05)。(3)多因素logistic回归分析提示子痫前期严重并发症独立危险因素为：发病孕周早(OR＝0.783,95%CI: 0.745～0.823)、高血肌酐(OR＝1.005,95%CI: 1.001～1.008)、低白蛋白(OR＝0.961,95%CI: 0.929～0.994)。 结论子痫前期严重并发症发生危险因素为发病孕周早、肾功能损害、低蛋白血症。     

母体潜在风险因素和不同产前检查与子痫前期发病特点

目的 探讨母体潜在风险因素在不同级别医院以及是否规律产前检查与子痫前期发病特点的关系. 方法 回顾分析300例在北京大学第三医院分娩的单胎妊娠子痫前期患者的临床资料.其中在三级医院、基层医院规律行产前检查和无规律产前检查者分别为100、81和119例.比较不同临床风险因素、产前检查情况者的子痫前期诊断孕周、重症发生情况.连续变量以中位数和四分位间距表示,采用非参数检验,分类变量采用卡方检验. 结果 (1)在总体病例、单纯子痫前期和合并慢性高血压者中,三级医院规律产前检查者(分别为100、64、14例)的子痫前期发病孕周[分别为37.1(4.1)、37.3(1.7)、36.3(2.5)周]比基层医院规律产前检查(分别为81、54、9例)的发病孕周[分别为32.9(6.7)、33.8(6.1)、27.9(6.3)周,Z值分别为72.29、51.30和14.58,P均＜0.05]和无规律产前检查者(分别为119、85、19例)子痫前期发病孕周[分别为31.6(6.6)、31.9(6.7)、30.3(4.7)周,Z值分别为86.69、58.83和11.33,P均＜0.05]明显延后；三级医院规律产前检查者比无规律产前检查者重症病例在妊娠32周前的发生率[分别为13.0％(13/100)与55.5％(66/119)、9.4％(6/64)与50.6％(43/85)、35.7％(5/14)与89.5％(17/19),x2值分别为43.95、29.42和10.17,P＜0.05)及妊娠34周前的发生率[分别为17.0％(17/100)与65.5％(78/119)、14.1％(9/64)与61.2％(52/85)、42.9％(6/14)与94.7％(18/19),x2值分别为47.71、31.18和10.61,P＜0.05]发生的比例明显降低.(2)在无规律产前检查组和基层医院规律产前检查组内,合并慢性高血压亚组比单纯子痫前期亚组的发病孕周明显提前(Z值分别为26.61和22.82,P＜0.05)；无规律产前检查组中,合并慢性高血压亚组比单纯子痫前期亚组的重症在妊娠32周前(x2=9.11,P＜0.05)和妊娠34周前(x2=7.95,P＜0.05)所占比例明显升高. 结论 三级医院规律产前检查可延缓子痫前期诊断孕周以及延缓重症发生时间,尤其对于存在子痫前期发病临床风险因素者.应加强早孕期子痫前期发病的临床风险评估,并建立以患者为基础的个体化系列产前检查计划.     

子痫前期高危因素的Logistic回归分析

目的:探讨影响子痫前期发病的主要高危因素及早期预测方法.方法:按照病例对照研究设计,对119例子痫前期病例和236例正常产妇对照组进行相关因素的回顾性调查,采用Logistic回归方法进行单因素和多因素分析,在此基础上建立子痫前期发病的预测模型,并对该模型进行初步评价.结果:孕前BMI≥24kg/m~2(OR=6.142,95%CI 3.361～11.225),高血压、糖尿病、肾炎疾病史(OR=14.092,95%CI 1.669～118.983),自然流产史(OR=3.008,95%CI1.160～7.801),高血压家族史(OR=3.050,95%CI 1.738～5.350)是子痫前期发病的主要危险因素.以Y=0.27作为判断界值,所建模型的后验灵敏度和特异度分别为68.1%和72.5%.结论:应加强对孕前BMI≥24 ks/m~2,有高血压、糖尿病、肾炎疾病史,有自然流产史及高血压家族史的妇女进行孕前及孕期保健,以预防及早期预测子痫前期的发生.     

单、双胎妊娠并发子痫前期不良妊娠结局的荟萃分析

目的探讨单、双胎妊娠并发子痫前期的孕妇与围产儿不良结局发病率差异。 方法检索PubMed、Web of Science、中国生物医学文献数据库、中国学术文献总库、万方和维普中文数据库中2000年1月至2017年12月国内外发表的关于单、双胎妊娠并发子痫前期妊娠结局的研究。采用RevMan 5.3与Stata 12.0软件对资料进行荟萃分析,采用OR值及相应的95%CI评价不良结局与双胎妊娠并发子痫前期的相关性。 结果纳入10篇文献,共692例双胎妊娠合并子痫前期,3101例单胎妊娠合并子痫前期。双胎妊娠合并子痫前期组发病率高于单胎妊娠合并子痫前期：胎盘早剥OR＝2.16,95%CI为1.40～3.36;产后出血OR＝2.90, 95%CI为2.03～4.15;心功能衰竭OR＝3.73, 95%CI为2.10～6.63 ;肺水肿OR＝2.76, 95%CI为1.04～7.27;剖宫产OR＝2.27, 95%CI为1.58～3.26;胎膜早破OR＝2.99, 95%CI为1.64～5.47;早产OR＝6.24,95%CI为4.16～9.38,新生儿重症监护病房转入率OR＝2.33, 95%CI为1.66～3.26。 结论双胎妊娠合并子痫前期的不良妊娠结局包括胎盘早剥、产后出血、心功能衰竭、肺水肿、剖宫产、胎膜早破、早产和新生儿重症监护病房转入的发病率比单胎妊娠合并子痫前期高。     

不同的妊娠间隔时间与高龄经产妇妊娠结局的关系

目的:探讨高龄经产妇不同妊娠间隔时间与妊娠结局(妊娠合并症、分娩并发症、新生儿窒息)的关系。方法:收集2019年1月至2020年6月在赣州市人民医院进行产前检查的高龄经产妇(其预产期年龄≥35岁) 205例作为研究对象。根据距上次妊娠间隔时间进行分组:A组(2～5年)97例、B组(6～9年) 63例、C组(≥10年) 45例。收集孕妇妊娠合并症、分娩方式、产程长短、分娩并发症、新生儿转科率及Apgar评分。比较各组妊娠结局的差异,以A组为对照,二分类Logistic回归分析评价妊娠间隔时间长短发生不同妊娠结局的风险。ROC曲线评估妊娠间隔时间预测发生不同妊娠结局的敏感性。结果:(1)A组、B组、C组经产妇的妊娠合并症、分娩并发症、第一产程时间、新生儿转科率和新生儿窒息程度整体上存在显著差异,A组不良妊娠结局的发生率最低,随妊娠间隔时间的延长,不良妊娠结局的发生率逐渐升高。(2)以A组作为参照,B组和C组发生妊娠期高血压、妊娠期糖尿病、胎膜早破、胎盘早剥、产后出血、羊水污染、新生儿窒息等结局的风险明显增加(P <0.05);加入年龄去除混杂因素后,与A组相比,B组发生胎膜早破(OR 2.35,95%CI 1.83～5.25,P=0.021)、胎盘早剥(OR 6.77,95%CI 3.46～12.73,P=0.000)的风险明显增加,C组发生妊娠期糖尿病(OR 3.86,95%CI 1.33～7.36,P=0.001)、胎膜早破(OR=6.92,95%CI 3.47～11.56,P=0.000),胎盘早剥(OR 12.88,95%CI 4.67～18.28,P=0.000)和新生儿窒息(OR4.82,95%CI 1.37～6.59、P=0.012)的风险显著增加。(3)ROC曲线表明,不同妊娠间隔时间预测发生妊娠期糖尿病、胎膜早破、胎盘早剥、新生儿窒息的敏感度分别为AUC=0.708,95%CI0.677～0.803; AUC=0.651,95%CI 0.556～0.683; AUC=0.606,95%CI 0.521～0.647; AUC=0.721,95%CI 0.681～0.788。结论:高龄孕妇发生不良妊娠结局的风险随着妊娠间隔时间的延长而逐渐增高。长妊娠间隔(6～9年、≥10年)是发生妊娠期糖尿病、胎膜早破、胎盘早剥、新生儿窒息的独立危险因素。     

Risk factors for placental abruption in a socio-economically disadvantaged region.

OBJECTIVE: This study was undertaken in order to determine the risk factors for pregnancies complicated by placental abruption in a socio-economically disadvantaged region in metropolitan Adelaide. METHODS: This was a retrospective case-control study including all singleton pregnancies resulting in placental abruption between 2001 and 2005. RESULTS: The overall incidence of placental abruption was 1.0%; the overall perinatal mortality among the births with abruption was 13%. Univariate analyses showed the following significant risk factors for placental abruption: preterm pre-labor rupture of the membranes (PRE-PROM; odds ratio (OR) 4.79, 95% confidence interval (CI) 1.52-15.08), non-compliance with antenatal care (OR 2.93, 95% CI 1.06-8.90), severe intrauterine growth restriction (IUGR), and elevated homocysteine levels (OR 45.55, 95% CI 7.05-458.93). Severe IUGR was significantly more common in the abruption group compared with the control group (p = 0.032). In the multivariate analysis, PRE-PROM remained a significant independent risk factor for placental abruption. Marijuana use, domestic violence, and mental health problems were more common (borderline significance) in the abruption group. Smoking and preeclampsia were not found to be associated with placental abruption in this study. CONCLUSIONS: In this high-risk population, PRE-PROM and elevated homocysteine levels appear to represent the major risk factors for placental abruption.     

子痫前期复发影响因素临床研究

目的 探讨子痫前期复发相关影响因素。方法 回顾分析2009年1月至2014年3月在北京大学第三医院产科住院并结束妊娠的有过子痫前期病史的82例临床病例资料,按照此次妊娠有无子痫前期复发分为复发子痫前期组（RPE组）和未复发子痫前期组（NRPE组）,并对两组资料进行对比分析。结果 2009年1月至2014年3月子痫前期总体发病率为6.6%（1182/17939）,82例有子痫前期病史者,再次妊娠子痫前期复发率为45.1%（37/82）。分析子痫前期复发影响因素：母体基础状况：有子痫前期病史的82例中,43.9%(36/82)合并内科疾病,其中以合并慢性高血压者最多,为34.1%（28/82）。RPE组合并内科疾病者（67.6%,25/37）、合并慢性高血压者（54.1%,20/37）均明显高于NRPE组[24.4%（11/45）、17.8%（8/45）],P<0.001、P=0.001。前次妊娠子痫前期发病情况：RPE组前次妊娠最高收缩压[180.0（160.0～200.0）mmHg]和最高舒张压[110.0（100.0～129.0）mmHg]均明显高于NRPE组[166.0(150.0～180.0)mmHg、100.0（98.5～120.0）mmHg],P=0.009、0.004。RPE组前次最高收缩压为140～159mmHg者所占比例（13.5%,5/37）低于NRPE组（35.0%,14/40）（P=0.029）,前次最高收缩压≥160mmHg者所占比例（86.4%,32/37）、前次最高舒张压≥110mmHg者所占比例（59.5%,22/37）、前次为重度高血压者所占比例（73.0%,27/37）均明显高于NRPE组[62.5%（25/40）、32.5%（13/40）、42.5%（17/40）],P=0.016、0.018、0.007。产前检查情况：RPE组中规律产前检查者所占比例（64.9%,24/37）、三级医院规律产前检查者所占比例（40.5%,15/37）均明显低于NRPE组[86.7%（39/45）、86.7%     

Risk factors for placental abruption in a socio-economically disadvantaged region

Objective. This study was undertaken in order to determine the risk factors for pregnancies complicated by placental abruption in a socio-economically disadvantaged region in metropolitan Adelaide.

Methods. This was a retrospective case–control study including all singleton pregnancies resulting in placental abruption between 2001 and 2005.

Results. The overall incidence of placental abruption was 1.0%; the overall perinatal mortality among the births with abruption was 13%. Univariate analyses showed the following significant risk factors for placental abruption: preterm pre-labor rupture of the membranes (PRE-PROM; odds ratio (OR) 4.79, 95% confidence interval (CI) 1.52–15.08), non-compliance with antenatal care (OR 2.93, 95% CI 1.06–8.90), severe intrauterine growth restriction (IUGR), and elevated homocysteine levels (OR 45.55, 95% CI 7.05–458.93). Severe IUGR was significantly more common in the abruption group compared with the control group (p = 0.032). In the multivariate analysis, PRE-PROM remained a significant independent risk factor for placental abruption. Marijuana use, domestic violence, and mental health problems were more common (borderline significance) in the abruption group. Smoking and preeclampsia were not found to be associated with placental abruption in this study.

Conclusions. In this high-risk population, PRE-PROM and elevated homocysteine levels appear to represent the major risk factors for placental abruption.     

Risk and risk estimation of placental abruption

OBJECTIVE: Several variables related to increased risk of placental abruption are also risk factors for venous thromboembolism. Prior second trimester-, third trimester, and repeated fetal loss are reported to be associated to thrombophilias. However, it is yet not known if they are also related to placental abruption. STUDY DESIGN: A retrospective case-control study of 161 women with placental abruption and 2371 unselected gravidae without placental abruption. The medical files were scrutinized and the selected variables were investigated in relation to the development of placental abruption. RESULTS: As compared to controls, previous second trimester-, third trimester-, repeated fetal loss, and prior placental abruption were related to a 3-, 13-, 3-, and a 25-fold increased risk of placental abruption, respectively. Several other factors were associated with a roughly three-fold increased risk such as: preeclampsia, IUGR, high maternal age (>35), family history of venous thromboembolism, smoking, and multiple birth. A risk score was created and as compared with those with no risk factors present, the risk of placental abruption was increasing from 2.5-fold for those with risk score=1, to almost 100-fold for risk score 4 or above. CONCLUSION: Easily obtainable information might be used to classify the risk of placental abruption.     

Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a meta-analysis of observational studies

OBJECTIVE: To systematically review the literature and summarize the relationship between cigarette smoking and placental abruption, and to evaluate the joint influences of smoking and hypertensive disorders (chronic hypertension and preeclampsia) on the subsequent development of abruption. DATA SOURCES: We reviewed studies identified through a MEDLINE literature search between 1966 and 1997 and through studies cited in the references of published reports. METHODS OF STUDY SELECTION: A total of 13 observational (seven case-control and six cohort) studies were identified which included a total of 1,358,083 pregnancies. We excluded case reports on placental abruption, and restricted the literature search to studies published in English. A meta-analysis was performed by computing pooled odds ratios based on random-effects models describing the association between placental abruption, smoking, and hypertensive disorders. Potential sources of heterogeneity among these studies were explored in detail. TABULATION, INTEGRATION, AND RESULTS: The overall incidence of placental abruption was 0.64% (8724 of 1,358,623). Smoking was associated with a 90% increase in the risk of placental abruption (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.8, 2.0). This pattern was consistent by study design (case-control compared with cohort studies) and smoking prevalence (low compared with high prevalence, defined as less than 30% compared with 30% or more, respectively). However, the association was significantly (p < .001) stronger among the seven studies conducted outside the United States (OR 2.1, 95% CI 2.0, 2.2), compared with the six studies conducted in the United States (OR 1.6, 95% CI 1.5, 1.8). Pooled population attributable risk percentage for each stratum ranged between 15% and 25%, implying that 15-25% of placental abruption episodes are attributable to cigarette smoking. Data on the dose-response relationship between number of cigarettes smoked per day and the risk of abruption indicate that the OR increased with increasing number of cigarettes smoked. Furthermore, a meta-analysis of the joint effects of smoking and hypertension during pregnancy on the development of abruption identified two published studies, including 102,609 pregnancies. In the presence of smoking, the risk of abruption was further increased due to chronic hypertension, mild or severe preeclampsia, or chronic hypertension with superimposed preeclampsia. CONCLUSION: Our meta-analyses showed an increased risk for placental abruption in relation to both cigarette smoking and hypertensive disorders during pregnancy. Because cigarette smoking is a modifiable risk factor, and hypertensive disorders are potentially treatable if diagnosed early in pregnancy, patient education, smoking cessation programs, and early prenatal care may be important factors in the prevention of placental abruption.     

Dalteparin and Low-Dose Aspirin in the Prevention of Adverse Obstetric Outcomes in Women With Inherited Thrombophilia

ObjectiveTo evaluate the benefit of treatment with dalteparin and low-dose aspirin (ASA) in the prevention of obstetric complications in women with inherited thrombophilia.MethodsA retrospective chart review identified women who had had at least one pregnancy complicated by severe early-onset preeclampsia, placental abruption, fetal growth restriction (FGR), or fetal death. The following inherited thrombophilias were included: deficiencies of antithrombin, protein C, or protein S, and mutations of factor V Leiden (G1691A), factor II (G20210A), or methylenetetrahydrofolate reductase C677T.ResultsThe records of 43 women with 110 pregnancies were included in the study. Anticoagulant prophylaxis was administered using dalteparin in 13 pregnancies, ASA with dalteparin in 26, and ASA alone in 11. Dalteparin alone and ASA alone showed equivalent effects in preventing preeclampsia and FGR. Combined dalteparin and ASA significantly decreased the risk of preeclampsia (odds ratio [OR] 0.80; 95% confidence intervals [CI] 0.70–0.91, P = 0.001) and FGR (OR 0.70; 95% CI 0.60–0.82, P = 0.001).ConclusionData from this retrospective cohort study suggest that combined treatment with dalteparin and ASA decreases the risk of preeclampsia by 20% and the risk of FGR by 30% in women with inherited thrombophilia.     

Prepregnancy risk factors for placental abruption

BACKGROUND: To define the prepregnancy risk factors for placental abruption. METHODS: One hundred and ninety-eight women with placental abruption and 396 control women without placental abruption were retrospectively identified among 46,742 women who delivered at a tertiary referral university hospital between 1997 and 2001. Relevant historical and clinical variables were compared between the groups. Multivariate logistic regression analysis was applied to identify independent risk factors. RESULTS: The overall incidence of placental abruption was 0.42%. Placental abruption recurred in 8.8% of the cases. The independent risk factors were smoking (OR 1.7; 95% CI 1.1, 2.7), uterine malformation (OR 8.1; 1.7, 40), previous cesarean section (OR 1.7; 1.1, 2.8), and history of placental abruption (OR 4.5; 1.1, 18). CONCLUSIONS: Although univariate analysis identified many risk factors, only smoking, uterine malformation, previous cesarean section, and history of placental abruption remained significant after multivariate analysis, increasing the risk of placental abruption in subsequent pregnancy. It may be possible to approximate the risk for placental abruption based on these simple prepregnancy risk factors.     

Risk factors for placental abruption in an Asian population

The objective of this study was to identify risk factors for placental abruption in an Asian population. The authors conducted a retrospective review of 37 245 Taiwanese women who delivered between July 1990 and December 2003. Pregnancies complicated by placenta previa, multiple gestation, and fetal anomalies were excluded. Multivariable logistic regression was used to adjust for potentially confounding variables and to identify independent risk factors for placental abruption. Three hundred thirty-two women had placental abruption (9 per 1000 singleton deliveries). Women who smoked during pregnancy (adjusted odds ratio [OR] = 8.4; 95% confidence interval [CI] = 3.0-23.9), had gestational hypertensive diseases (adjusted OR = 4.9; 95% CI = 3.3-7.3), pregnancies complicated by oligohydramnios (adjusted OR = 4.2; 95% CI = 2.7-6.7), polyhydramnios (adjusted OR = 3.3; 95% CI = 1.4-7.7), preterm premature rupture of membranes (adjusted OR = 1.9; 95% CI = 1.1-3.1), entanglement of umbilical cord (adjusted OR = 1.6; 95% CI = 1.2-2.1), were of or more than 35 years of age (adjusted OR = 1.5; 95% CI = 1.1-2.0), and had a low prepregnancy body mass index (adjusted OR = 1.3; 95% CI = 1.0-1.6) were at increased risk for placental abruption. Some risk factors for placental abruption among Taiwanese women are the same as those of other ethnic groups, whereas some of the risk factors are different.     

Maternal complications and perinatal outcomes associated with gestational hypertension and severe preeclampsia in Taiwanese women.

BACKGROUND/PURPOSE: The role of proteinuria in disease severity of preeclampsia and gestational hypertension has not been determined. The objective of this study was to compare the effects of disease severity on maternal complications and pregnancy outcome between women with severe preeclampsia and women with gestational hypertension. METHODS: A retrospective case-control study using daily records from the birth registry for the years 1994 to 2003 was conducted. Cases (n = 364) were defined as women with severe preeclampsia. Controls (n = 249) were selected from women with gestational hypertension. The outcome measures were maternal complications and perinatal-related factors. RESULTS: Women with severe preeclampsia had an increased risk of intrauterine growth restriction (adjusted odds ratio [aOR], 2.16; 95% confidence interval [CI], 1.10-4.24; p = 0.026). Risk factors associated with severe preeclampsia patients were lack of prenatal care (aOR, 2.95; 95% CI, 1.45-5.99), systolic blood pressure >or= 180 mmHg (aOR, 14.3; 95% CI, 1.69-121.0), and diastolic blood pressure >or= 105mmHg (aOR, 21.2; 95% CI, 6.99-64.3) compared with women with gestational hypertension in Model I. When we added proteinuria as a variable, two significant risk factors, diastolic blood pressure >or= 105mmHg (aOR, 18.2; 95% CI, 4.85-68.3) and significant proteinuria (aOR, 1.01; 95% CI, 1.006-1.014), were associated with severe preeclampsia patients in Model II. A subgroup of women with gestational hypertension and proteinuria had an increased risk of placental abruption (unadjusted OR, 4.36; 95% CI, 1.05-18.1) and disseminated intravascular coagulation (unadjusted OR, 6.46; 95% CI, 1.05-39.8). Finally, maternal complications (aOR, 2.59; 95% CI, 1.34-5.04) became the single significant factor associated with gestational hypertension and proteinuria. CONCLUSION: Proteinuria may play a role in the progression of gestational hypertension to severe forms of preeclampsia associated with subsequent maternal complications and extremely-low-birth-weight babies.