再次剖宫产终止妊娠的时机对围产期结局影响

发布时间：2018-06-08 08:10

本文选题：再次剖宫产 + 择期剖宫产　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的：分析不同孕周行择期再次剖宫产的母儿围产期结局，探讨再次剖宫产的最佳终止妊娠时机。方法：回顾性收集重庆医科大学附属第一医院（简称本院）产科电子病历系统记录的自2011年6月至2013年6月住院分娩的所有产妇的资料。选择妊娠满37周无妊娠合并症或基础疾病的宫内单活胎、择期行再次剖宫产的孕妇为研究对象，并根据不同孕周进行分组。采用单因素方差分析或χ2检验比较不同孕周终止妊娠的孕产妇的一般情况和妊娠结局以及新生儿不良事件的发生情况。结果：共579例足月行再次剖宫产的产妇纳入本研究，其中妊娠39周前手术者与39~周手术者的比例分别为64.6%（374/579），其中37~周分娩者93例，38~周分娩者281例）和29.0%（168/579），无产妇、胎儿或新生儿死亡。妊娠37~周、38~周、39~周、40~周和≥41周分娩的产妇2次剖宫产间隔时间差异无统计学意义（P0.05），住院时间差异有统计学意义。不同孕周分娩的产妇的终止妊娠时体质量指数、胎盘胎膜残留、术中术后出血、胎膜早破、转重症监护病房和子宫切除等指标差异均无统计学意义（P值均0.05）。5组分娩新生儿的出生体重和出生身长差异均有统计学意义，1min和5min Apgar评分差异亦有统计学意义。5组新生儿不良事件发生率包括转新生儿重症监护病房（Neonatal intensive care unit，NICU）、接受心肺复苏或呼吸机治疗、窒息和住NICU≥5d的比例差异有统计学意义。以妊娠39~周终止妊娠为标准，妊娠37~周、38~周行再次剖宫产所分娩的新生儿不良事件的发生风险（OR值及其95%CI）分别为1.1（1.0~2.1）和1.3（0.9~1.9）。结论：提前终止妊娠并未降低孕产妇不良妊娠结局的发生率，但却增加新生儿呼吸系统疾病等不良事件的发生风险。而本院妊娠39周前行择期再次剖宫产的比例较高，因此，，在兼顾孕妇安全的前提下，为减少新生儿不良事件的发生风险，建议将妊娠39~39+6周作为择期再次剖宫产的最佳时机。
[Abstract]:Objective: to analyze the perinatal outcome of women undergoing elective cesarean section at different gestational weeks, and to explore the best time to terminate pregnancy.
Methods: the data of all parturient who were hospitalized from June 2011 to June 2013 in the obstetric medical record system of First Affiliated Hospital of Chongqing Medical University were collected retrospectively. The pregnant women with no pregnancy complications or basic diseases were selected for 37 weeks of pregnancy. A single factor analysis of variance or a chi 2 test was used to compare the general situation and pregnancy outcome of pregnant and parturient women with different gestational weeks and the occurrence of adverse events of the newborn.
Results: a total of 579 parturients for full term cesarean section were included in this study, of which 39 weeks before pregnancy and 39~ weeks were 64.6% (374/579), of which 93 were given birth in 37~ weeks, 281 in 38~ weeks, 29% (168/579), no parturients, fetal or neonatal deaths. 38~ weeks, 39~ weeks, 40~ weeks, and more than 41 weeks of childbirth. There was no statistically significant difference in the interval between 2 parturients in cesarean section (P0.05), and there was significant difference in the time of hospitalization. There was no significant difference in the index of body mass index, placenta and fetal membrane residue, intraoperative bleeding, premature rupture of membranes, conversion to intensive care unit and hysterectomy in different gestational weeks (P value was all 0.05). The difference of birth weight and birth length of newborn infants in.5 group was statistically significant, and the difference of 1min and 5min Apgar scores also had statistical significance in the incidence of neonatal adverse events in group.5, including the transfer of neonatal intensive care unit (Neonatal intensive care unit, NICU), cardiopulmonary resuscitation or ventilator treatment, asphyxia and NICU > 5D. The difference in proportion was statistically significant. The risk of adverse events (OR and 95%CI) of newborn infants delivered after 39~ week of cesarean section (OR and 95%CI) was 1.1 (1.0~2.1) and 1.3 (0.9~1.9) respectively, with the standard of termination of pregnancy as the standard of pregnancy, week of pregnancy and 38~ weeks after cesarean section.
Conclusion: early termination of pregnancy does not reduce the incidence of undesirable pregnancy outcomes in pregnant and lying in women, but increases the risk of adverse events such as neonatal respiratory diseases. The rate of secondary cesarean section in the 39 weeks of pregnancy is higher in our hospital. Therefore, the risk of neonatal adverse events is reduced on the premise of taking into account the safety of pregnant women. It is suggested that 39~39+6 weeks of pregnancy be the best time to choose the second cesarean section.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R719.82

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