目的:首次分娩期间接受子宫动脉栓塞术(UAE)的妇女第二次分娩的母婴结局如何?
结论:首次分娩期间接受UAE的妇女出现胎盘问题的风险更高,早产,和产后出血(PPH)在第二次分娩和第二个后代也显示出增加的主要先天性畸形的风险,入院新生儿重症监护病房(NICU),坏死性小肠结肠炎,脑室内出血,支气管肺发育不良.
背景:UAE是一种微创手术,可替代子宫切除术,用于治疗严重的PPH。然而,最近的研究引起了人们对潜在产科并发症的担忧,包括复发性PPH,胎盘植入谱(PAS),和胎儿生长受限在随后的分娩阿联酋。
■这是一项全国性的回顾性队列研究,使用韩国国家健康保险服务(K-NHIS)数据库,从2004年到2020年,覆盖5000万人。该队列包括2005年1月1日至2019年12月31日期间的3.616.923名活产妇女,随访数据延长至2020年12月31日。
方法:该研究包括2005年至2019年首次活产的妇女,不包括接受子宫切除术的妇女(无UAE=3.612.389,UAE=4534)。其中,我们选择了单胎二次分娩的女性(无UAE=1.694.600,UAE=1146).倾向得分匹配用于控制混杂因素,结果11.184名没有阿联酋的女性和1119名患有阿联酋的女性进行后续分析。
结果:UAE组中的女性患PAS的风险明显更高(比值比(OR)=38.91,95%CI=18.61-81.34),前置胎盘(OR=6.98,95%CI=5.57-8.75),和第二次分娩期间的早产(OR=2.23,95%CI=1.71-2.90)。复发PPH的风险也显著升高(OR=8.94,95%CI=7.19-11.12)。他们的第二个后代更可能有严重的先天性畸形(OR=1.62,95%CI=1.25-2.11)和不良的新生儿结局。包括NICU入院(OR=1.83,95%CI=1.48-2.25)。长期结果显示,注意力缺陷/多动障碍的风险更高(风险比=1.64,95%CI=1.03-2.63),但在其他方面与无UAE组相当。
结论:本研究的回顾性性质可能引入了暴露和结果错误分类,尽管K-NHIS数据库的可靠性。由于仅包括活产,无法测量的混杂因素和选择偏见也可能影响结果。
结论:有UAE病史的妇女在后续分娩期间需要细致的产前护理和密切监测,因为并发症的风险增加。咨询和转诊到高风险医疗中心可能会改善结果。需要进一步的研究来了解顺序分娩时母亲和后代并发症的机制。以及完善阿联酋程序。
背景:这项研究由卫生和福利部资助的以患者为中心的临床研究协调中心(PACEN)支持,大韩民国(HC21C0123)。本研究由S.-Y.O.资助。本手稿的作者声明与任何产品或服务可能与文章主题相关的公司没有关系。
背景:不适用。
OBJECTIVE: What are the maternal and neonatal outcomes of second delivery in women who underwent uterine artery embolization (UAE) during their first delivery?
CONCLUSIONS: Women who underwent UAE during their first delivery exhibited higher risks of placental problems, preterm births, and postpartum hemorrhage (PPH) in second delivery and the second offspring also showed increased risk of major congenital malformations, admission to the neonatal intensive care units (NICU), necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia.
BACKGROUND: UAE is a minimally invasive procedure used as an alternative to hysterectomy for managing severe PPH. However, recent studies have raised concerns about potential obstetric complications, including recurrent PPH, placenta accreta spectrum (PAS), and fetal growth restriction in subsequent delivery following UAE.
UNASSIGNED: This was a nationwide retrospective cohort study using the Korean National Health Insurance Service (K-NHIS) database, covering 50 million individuals from 2004 to 2020. The cohort included 3 616 923 women with live births between 1 January 2005 and 31 December 2019 with follow-up data extending to 31 December 2020.
METHODS: The study included women who had their first live birth between 2005 and 2019, excluding those who underwent hysterectomy (without UAE = 3 612 389, UAE = 4534). Among them, we selected women who had single gestation secondary delivery (without UAE = 1 694 600, UAE = 1146). Propensity score matching was used to control for confounding factors, resulting in 11 184 women without UAE and 1119 women with UAE for subsequent analysis.
RESULTS: Women in the UAE group had significantly higher risks of PAS (odds ratio (OR) = 38.91, 95% CI = 18.61-81.34), placenta previa (OR = 6.98, 95% CI = 5.57-8.75), and preterm birth (OR = 2.23, 95% CI = 1.71-2.90) during their second delivery. The risk of recurrent PPH was also significantly higher (OR = 8.94, 95% CI = 7.19-11.12). Their second offspring were more likely to have major congenital malformations (OR = 1.62, 95% CI = 1.25-2.11) and adverse neonatal outcomes, including NICU admissions (OR = 1.83, 95% CI = 1.48-2.25). Long-term outcomes showed a higher risk of attention-deficit/hyperactivity disorder (hazard ratio = 1.64, 95% CI = 1.03-2.63) but were otherwise comparable to those in the without UAE group.
CONCLUSIONS: Retrospective nature of the study may have introduced exposure and outcome misclassifications, despite the reliability of the K-NHIS database. Unmeasured confounders and selection bias due to only including live births could also have influenced the results.
CONCLUSIONS: Women with a history of UAE require meticulous prenatal care and close monitoring during subsequent deliveries due to increased risks of complications. Counseling and referral to high-risk medical centers may improve outcomes. Further research is needed to understand the mechanisms of complications in both mothers and offspring at sequential delivery, as well as to refine UAE procedures.
BACKGROUND: This study supported by Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (HC21C0123). This study was funded by S.-Y.O. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
BACKGROUND: N/A.