Predictors of Vaginal Delivery among Patients Admitted with Severe Preeclampsia.

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

American journal of perinatology Pub Date : 2025-01-01 Epub Date: 2024-08-29 DOI:10.1055/a-2405-1778

Sabrena Myers, Abigail Pyne, Alice Darling, Noor Al-Shibli, Jennifer J M Cate, Matthew R Grace, Sarahn Wheeler, Sarah K Dotters-Katz

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引用次数: 0

Abstract

Objective: This study aimed to assess the rates of vaginal delivery (VD) and the predictors of VD in a cohort of patients with early (<34 weeks) preeclampsia with severe features (Early Severe PreEClampsia [ESPEC]).

Study design: We conducted a retrospective cohort study of patients with ESPEC admitted to a single center from 2013 to 2019. Exclusion criteria included patients with contraindications to labor, multifetal gestation, or presenting in spontaneous labor. Patient characteristics were abstracted. The primary outcome was rate of VD. Secondary outcome was factors associated with VD. Secondary analysis performed including only primiparous patients. Bivariate statistics and logistic regression were used to analyze data.

Results: Of 229 patients with ESPEC, 184 (80%) were candidates for labor. Of those, 74 (40%) underwent prelabor cesarean delivery (CD). Among the 110 remaining patients who attempted VD, 47 (43%) were successful. No significant differences in characteristics between VD and CD patients were found on bivariate analysis. In regression models, BMI ≥ 40 was associated with increased odds of CD (adjusted odds ratio [aOR]: 2.83, 95% confidence interval [CI]: 1.01, 7.95), whereas private insurance was associated with reduced odds of CD (aOR: 0.37, 95% CI: 0.16, 0.86). In planned secondary analysis of primiparous patients, 101/123 (82%) were candidates for labor. Of those, 29 underwent prelabor CD. The VD rate among primiparous patients attempting labor was 40% (29/72). In this subgroup, private insurance was associated with VD (71 vs. 46%, p = 0.03). In regression models, only private insurance remained associated with CD (aOR: 0.30, 95% CI: 0.10, 0.92).

Conclusion: Patients with ESPEC who attempted VD were successful less than half of the time, with similar rates among the subset of primiparous patients. BMI ≥ 40 was associated with increased odds of CD, whereas private insurance was associated with reduced odds of CD. These data may aid providers in counseling patients with ESPEC on the likelihood of successful VD.

Key points: · Only 43% of ESPEC patients who attempted VD were successful.. · Subset of primiparous patients w/ESPEC had similar VD rate.. · BMI ≥40 kg/m2 in ESPEC patients was associated with increased odds of CD..

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重度子痫前期患者阴道分娩的预测因素

研究目的本研究旨在评估一组早期ESPEC患者的阴道分娩率和阴道分娩的预测因素：我们对 2013-2019 年间在一家中心住院的 ESPEC 患者进行了一项回顾性队列研究。排除标准包括有分娩禁忌症、多胎妊娠或自然分娩的患者。对患者特征进行了摘要分析。主要结果是VD发生率。次要结果是与顺产相关的因素。仅对初产妇进行二次分析。采用双变量统计和逻辑回归分析数据：在229名ESPEC患者中，184人（80%）适合分娩。其中，74 人（40%）进行了产前剖宫产（CD）。其余110名尝试顺产的患者中，47人（43%）顺产成功。经双变量分析，VD 和 CD 患者的特征无明显差异。在回归模型中，体重指数≥40 与 CD 的几率增加有关（aOR:2.83, 95%CI:1.01,7.95），而私人保险与 CD 的几率降低有关（aOR:0.37, 95%CI:0.16,0.86）。在计划对初产妇进行的二次分析中，101/123（82%）名初产妇符合分娩条件。其中 29 人接受了产前 CD。初产妇待产率为 40%（29/72）。在这个亚组中，私人保险与VD相关（71%vs46%,P=0.03）。在回归模型中，只有私人保险仍与CD相关（aOR:0.30, 95%CI:0.10,0.92）：结论：尝试阴道分娩的ESPEC患者只有不到一半的成功率，初产妇的成功率与之相似。体重指数≥40与阴道分娩几率增加有关，而私人保险与阴道分娩几率降低有关。这些数据可能有助于医疗服务提供者向ESPEC患者提供有关阴道分娩成功几率的咨询。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of perinatology 医学-妇产科学

CiteScore

5.90

自引率

0.00%

发文量

302

审稿时长

4-8 weeks

期刊介绍： The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.