WHO四次产前检查模式在山西的临床应用研究

发布时间：2018-03-24 08:50

本文选题：WHO　切入点：产前检查　出处：《山西医科大学》2014年硕士论文

【摘要】：目的：高质量的产前检查，是降低围产期母婴并发症、保护母儿健康的重要措施。目前我国实施的传统产前检查模式，包括12～14次定期产前检查，但各地区、各层次人群对产前检查的依从性仍不平衡，产前检查服务不能得到有效利用，一些孕产妇很难按规定时间、次数、内容完成产前检查项目，导致妊娠并发症难以得到早期发现和治疗，疾病发展成高危的风险增加；基于循证医学证据的基础上，世界卫生组织于2002年、2006年提出并明确了四次产前检查应分别于孕＜16孕周、24-26孕周、30-32孕周、36-38孕周进行。2011年我院多次进行的WHO四次产前检查模式小样本研究表明，新的产前检查模式节约了医疗资源，减轻了孕妇的心理、经济负担。本研究在前期研究的基础上，增加不同医院的产前检查人群，扩大样本进行人群研究，通过比较WHO四次产前检查模式与传统产前检查模式的妊娠结局，探讨WHO四次产前检查模式在孕期保健中的有效性，同时观察不同妊娠期孕妇体重增加值和体成分的变化趋势，分析其与新生儿出生体重之间的关系。方法：选取2012年8月至2014年3月在山西省指定的三家医院产科门诊进行产前检查的976例单胎孕妇作为目标人群，随访共计950例，研究组202例，对照组748例，共失访26例（2.7%）。在首次就诊时，排除高危因素、按照纳入标准：既往月经规律，就诊时小于16孕周；孕妇年龄范围在23-34岁；单胎妊娠；初产妇；无合并重大内科疾病。分别获得孕妇两种产前检查模式知情同意后，建立前瞻性观察队列，其中215例孕妇作为观察组，采用WHO四次产前检查模式，结合食物模型，用24小时膳食回顾法调查孕妇妊娠期膳食摄入情况，并测定孕妇体成分；761例孕妇作为对照组，采用传统产前检查模式。现场收集每次产前检查的孕妇信息，详细记录，直至分娩。采用SPSS17.0软件进行统计学处理，计量资料的描述采用x s表示，计量资料的显著性检验采用t检验，组间率比较采用X2检验。分别对可能影响新生儿出生体重的四个不同妊娠期体成分进行多重线性回归与相关分析，并对不同孕期的体成分对新生儿体重影响因素做重复测量分析。对孕妇孕期体重增加值和新生儿出生体重之间的相关性做双变量线性回归与相关分析，并构建回归方程。比较两组孕妇基线资料、孕期并发症及合并症发生率、围产儿不良妊娠结局、孕期体重增加值有无差异，分析孕期体重增加值、孕妇体成分与新生儿出生体重之间的相关关系。P＜0.05为差异有统计学意义。结果：1.两组孕妇在年龄、孕前体重、身高方面差异无统计学意义(P＞0.05)。 2.与传统产前检查模式组相比，，WHO四次产前检查模式组在妊娠合并贫血、早产、妊娠期高血压疾病、妊娠期糖尿病、胎膜早破的发生率偏低，差异具有统计学意义(P＜0.05)，剖宫产率的比较无统计学差异（P＞0.05）；出生低体重儿、早产儿、巨大儿的发生率偏低，差异有统计学意义（P＜0.05），新生儿窒息、新生儿呼吸窘迫、死胎的发生率比较，无统计学差异（P＞0.05）。3. WHO四次产前检查模式组的孕妇妊娠期体重增加值、新生儿出生体重与传统产前检查模式组比较无统计学差异。孕妇妊娠期体重增加值与新生儿出生体重呈线性正相关（r=0.783，P＜0.001）。按生育低出生体重儿、正常出生体重儿、巨大儿所对应的孕产妇分组，三组孕妇孕期体重增加值之间比较有显著性差异(P值均＜0.001)。4.在妊娠早期，孕妇总体水、肌肉重、去脂体重与新生儿出生体重之间存在正相关关系（P＜0.05)；孕中期，总体水、肌肉重、去脂体重与新生儿出生体重之间存在正相关关系（P＜0.01)，细胞外液、脂肪重与新生儿出生体重之间存在负相关关系（P＜0.05)；在30～32孕周时，孕妇去脂体重与新生儿出生体重之间存在正相关关系（P＜0.05)；在36～38孕周时，孕妇总体水、肌肉重、去脂体重与新生儿出生体重之间存在正相关关系（P＜0.05)；细胞外液与新生儿出生体重之间存在负相关关系（P＜0.01)。结论： 1.对于低危孕妇，WHO四次产前检查模式在孕期保健中的效能优于传统产前检查模式，不会增加妊娠期并发症和新生儿不良结局的发生。 2.孕妇妊娠期体重增加值与新生儿出生体重之间呈正相关关系，孕妇妊娠期体成分中的总体水、细胞外液、肌肉重、脂肪重、去脂体重可以较好反映妊娠期体重增长的具体情况，去脂体重可能成为新生儿出生体重的有效预测指标。
[Abstract]:Objective: prenatal examination of high quality, is to reduce maternal and perinatal complications, an important measure to protect the health of mother and infant. The traditional prenatal examination of the implementation, including the 12~14 regular antenatal examination, but in different areas, people at all levels of compliance on prenatal examination is not balanced, the prenatal care service not available some pregnant women, it is difficult to according to the prescribed time, the number of completed antenatal examination, pregnancy complications caused difficult to early detection and treatment of disease, increase the risk of development of risk; based on the evidence of evidence-based medicine, the WHO in 2002, proposed in 2006 and four times of prenatal examination should be clear in pregnancy less than 16 gestational week, 24-26 weeks, 30-32 weeks, 36-38 weeks of gestation in our hospital during.2011 times WHO four times of prenatal examination of small sample studies show that prenatal examination of new savings The medical resources, reduce the economic burden of pregnant women's psychology, this study. On the basis of previous studies, to increase the population of different hospital antenatal examination, expand the sample population study, through the pregnancy outcome between the four WHO prenatal prenatal examination mode and traditional mode, to explore the effectiveness of WHO four times of prenatal examination during pregnancy in health care, observation of the different gestational weight gain and body composition change trend value, analyze the relationship between body weight and neonatal birth.
Methods: from August 2012 to March 2014 for prenatal examination in three hospitals in Shanxi Province designated the 976 singleton pregnant women as the target population, a total of 950 follow-up cases, 202 cases of the study group, the control group of 748 cases, a total of 26 cases were lost (2.7%). In the first visit, eliminate risk factors, according to inclusion standard: Previous menstrual regularity, were less than 16 weeks of gestation; pregnant women in the age range of 23-34 years of age; single pregnancy; primipara; with major medical diseases. Two pregnant women received prenatal examination after informed consent, a prospective observation team, of which 215 cases of pregnant women as the observation group, using WHO four prenatal examination, combined with the food model, with 24 hour dietary recall method survey of pregnant women dietary intake, and determination of body composition of pregnant women; 761 cases of pregnant women as control group, using the traditional prenatal examination mode. The collection time Prenatal care of pregnant women with information, records, until delivery. Statistical analysis was carried out using SPSS17.0 software, the measurement data description expressed by x s, significant test measurement data using t test, the rate between groups were compared by X2 test. On May four different pregnancy body composition affect birth weight of newborns were analyzed using multiple linear regression and correlation analysis, and body composition of different pregnancy factors of neonatal weight make repeated measurements analysis. Value added of pregnant women and neonatal birth weight weight correlation between two variables linear regression and correlation analysis, and construct the regression equation. The two groups were compared at baseline, the incidence of pregnancy complications. Perinatal adverse pregnancy outcome, pregnancy weight gain differences between the values, analysis of pregnancy weight gain value between neonatal birth weight and body composition of pregnant women. The relationship of.P < 0.05 was statistically significant.
Results: there was no significant difference in age, weight and height between 1. groups in two groups of pregnant women (P > 0.05).
2. compared with the traditional prenatal examination group, WHO four group in the prenatal examination of pregnant women with anemia, premature birth, gestational hypertension, gestational diabetes, the incidence of premature rupture of membranes is low, the difference was statistically significant (P < 0.05), the rate of cesarean section had no significant difference (P > 0.05); low birth weight, premature infants, the low incidence rate of macrosomia, the difference was statistically significant (P < 0.05), neonatal asphyxia, neonatal respiratory distress, compared to the incidence of stillbirth, no significant difference (P > 0.05).3. WHO four prenatal check pattern group of pregnancy weight gain, neonatal birth the weight and the traditional prenatal examination group showed no significant difference. Pregnancy weight gain was positively correlated with neonatal birth weight (r=0.783, P < 0.001). According to the growth of low birth weight infants, children with normal birth weight and macrosomia of The packet should be maternal weight gain during pregnancy, the three groups had significant difference between the values (P < 0.001).4. early in pregnancy, pregnant women overall water, muscle weight, there is a positive correlation between body fat and neonatal birth weight (P < 0.05); the second trimester, total body water and muscle weight. There is a positive correlation between body fat and neonatal birth weight (P < 0.01), extracellular fluid, fat weight and birth weight has a negative correlation between (P < 0.05); at 30~32 weeks of gestation, there is a positive correlation between maternal body fat and the birth weight of newborns (P < 0.05); in 36~38 weeks of gestation, pregnant women overall water, muscle weight, there is a positive correlation between body fat and neonatal birth weight (P < 0.05); there is a negative correlation between extracellular fluid and neonatal birth weight (P < 0.01).
Conclusion:
1., for low risk pregnant women, the efficacy of WHO four prenatal care mode in pregnancy care is better than that of traditional prenatal care mode, which will not increase pregnancy complications and neonatal adverse outcomes.
2. pregnant women during pregnancy weight gain was positively correlated with neonatal weight, pregnant period overall water body composition, extracellular fluid, muscle weight, fat weight, fat free weight can reflect the specific circumstances of pregnancy weight gain, effective predictors of LBW as neonatal birth weight.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.7

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