出生的时间来改善慢性或妊娠高血压的结果:WILL RCT
Katie Kirkham1, Eleni Gkini1, Catherine Moakes1
1Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.
Health technology assessment (Winchester, England)
|January 20, 2026
概括
患有高血压的妇女的早产是安全的,没有增加母亲或新生儿并发症的风险. 在38周的计划分娩为健康妇女提供了可行的选择.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 临床试验研究 临床试验研究
背景情况:
- 患有慢性或妊娠性高血压的妇女面临的风险包括孕产妇并发症,剖腹产和预期护理的死产.
- 目前的管理涉及密集监测,但缺乏关于最佳出生时间的高质量数据.
- 早产 (37-38周) 可能会减少一些并发症,但可能会增加新生儿发病率.
研究的目的:
- 为了确定患有慢性或妊娠高血压的孕妇的最佳分娩时间,而这些孕妇在其他情况下则已满期.
- 为了在这个患者群体中比较计划的早产和常规的产期护理.
主要方法:
- 一个务实的,没有掩饰的,多中心的随机试验,涉及50家英国医院的403名参与者.
- 参与者被随机分配到38周计划的早产 (干预) 或在期内通常的护理 (控制).
- 首要结局包括母亲的不良结果和新生儿护理单位的入院,以及剖腹产出生率的二次分析.
主要成果:
- 由于招募率低 (目标的37%),试验被提前停止,干预组有201人,对照组有202人.
- 与对照组 (39.3周) 相比,干预组 (38.4周) 的出生时间平均提前0.9周.
- 在母亲的不良结果 (13%对12%),新生儿护理单位的入院 (7%对7%) 或剖腹产率 (29%对36%) 中没有发现显著差异.
结论:
- 对于患有慢性或妊娠性高血压的妇女而言,在38周计划分娩是一个安全的临床选择,没有增加孕产妇或新生儿发病率.
- 尽管面临招聘挑战,但研究结果表明,计划早产是通常护理的可行替代方案,结果相似.
- 计划进行进一步的研究,可能通过个人参与者数据的元分析,以探索对剖腹产率的影响.
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