Chorioamniotic Membrane Separation after Fetal Spina Bifida Repair: Impact of CMS Size and Patient Management.

IF 1.6 3区医学 Q3 OBSTETRICS & GYNECOLOGY Fetal Diagnosis and Therapy Pub Date : 2024-07-26 DOI:10.1159/000540510

Julia Wawrla-Zepf, Ladina Vonzun, Ladina Rüegg, Nele Strübing, Franziska Krähenmann, Martin Meuli, Luca Mazzone, Ueli Moehrlen, Nicole Ochsenbein-Kölble

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引用次数: 0

Abstract

Introduction: Chorioamniotic membrane separation (CMS) is a known complication after fetal spina bifida (fSB) repair. This study's goal was to analyze women's outcomes with open fSB repair and CMS (group A) compared to the ones without (group B) and to assess the influence of CMS size and patient management.

Methods: A total of 194 women with open fSB repair at our center were included in this retrospective study. Outcomes of group A were compared to the ones of group B. Regression analysis was performed to assess risk factors for CMS. Two subgroup analyses assessed the impact of CMS size (small [A-small] vs. large [A-large]) as well as patient management (A1 = hospitalization vs. A2 = no hospitalization) on pregnancy outcomes.

Results: Of 194 women, 23 (11.9%) were in group A and 171 (88.1%) in group B. Preterm premature rupture of membranes (PPROMs) (69.6% vs. 24.1%, p = <0.001), amniotic infection syndrome (AIS) (22.7% vs. 7.1%, p = 0.03), histologically confirmed chorioamnionitis (hCA) (40.0% vs. 14.7%, p = 0.03), length of hospital stay (LOS) after fSB repair (35 [19-65] vs. 17 [14-27] days), and overall LOS (43 [33-71] vs. 35 [27-46] days, p = 0.004) were significantly more often/longer in group A. Gestational age (GA) at delivery was significantly lower in group A compared to group B (35.3 [32.3-36.3] vs. 36.7 [34.9-37.0] weeks, p = 0.006). Regression analysis did not identify risk factors for CMS. Subgroup analysis comparing CMS sized in group A-small versus A-large showed higher AIS rate (42% vs. 0%, p = 0.04), lower LOS (22.0 [15.5-42.5] vs. 59.6 ± 24.1, p = 0.003). Comparison of group A1 versus A2 showed longer LOS (49.3 ± 22.8 vs. 15 [15-17.5] days, p < 0.001), lower planned readmission rate (5.6% vs. 80%, p = 0.003).

Conclusion: CMS significantly increased the risk of PPROM, AIS, hCA, caused longer LOS, and caused lower GA at delivery. Women with small CMS had higher AIS rates but shorter LOS compared to women with large CMS, while apart from LOS pregnancy outcomes did not differ regarding patient management (hospitalization after CMS yes vs. no).

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胎儿脊柱裂修补术后的绒毛膜羊膜分离术（CMS）：CMS 大小和患者管理的影响。

简介绒毛膜羊膜分离（CMS）是已知的胎儿脊柱裂（fSB）修复术后并发症。本研究的目的是分析开放式脊柱裂修补术后合并 CMS 的妇女（A 组）与未合并 CMS 的妇女（B 组）的疗效比较，并评估 CMS 大小和患者管理的影响。将 A 组与 B 组的结果进行比较。进行回归分析以评估CMS的风险因素。两个亚组分析评估了CMS大小（局部（A-局部）与全局（A-全局））以及患者管理（A1=住院与A2=不住院）对妊娠结局的影响：早产胎膜早破（PPROM）（69.6% vs. 24.1%，P = 0.001）、羊膜感染综合征（AIS）（22.7% vs. 7.1%，P = 0.03）、组织学证实的绒毛膜羊膜炎（hCA）（40.0% vs. 14.7%，P = 0.03）、住院时间（A2=不住院）、妊娠结局（B2=无妊娠结局）。与 B 组相比，A 组分娩时的胎龄（GA）明显较低（35.3（32.3-36.3）周 vs. 36.7（34.9-37.0）周，p = 0.006）。回归分析未发现 CMS 的风险因素。比较 A 组本地与 A 组全球的 CMS 大小的分组分析显示：AIS 率较高（42% vs. 0%，p = 0.04），LOS 较低（22.0 (15.5-42.5) vs. 59.6 ± 24.1，p = 0.003）。A1 组与 A2 组的比较显示：LOS 更长（49.3 ± 22.8 对 15 (15-17.5) 天，p <0.001），计划再入院率更低（5.6% 对 80%，p = 0.003）：CMS明显增加了PPROM、AIS和hCA的风险，导致更长的LOS和更低的GA。与全身性 CMS 的产妇相比，局部性 CMS 的产妇 AIS 发生率更高，但 LOS 更短，而除了 LOS 外，妊娠结局与患者管理（CMS 后住院与否）并无差异。

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

Fetal Diagnosis and Therapy 医学-妇产科学

CiteScore

4.70

自引率

9.10%

发文量

审稿时长

6-12 weeks

期刊介绍： The first journal to focus on the fetus as a patient, ''Fetal Diagnosis and Therapy'' provides a wide range of biomedical specialists with a single source of reports encompassing the common discipline of fetal medicine.