妊娠合并轻度危险因素不同分娩方式对妊娠结局的影响

发布时间：2019-02-16 20:24

【摘要】：目的研究具有单项轻度危险因素的单胎妊娠初产妇,分娩方式对妊娠结局的影响,为降低轻度危险妊娠剖宫产(cesarean delivery, CD)率提供科学依据。 方法对2005年1月1日至2013年12月31日九年间在昆明医科大学第一附属医院产科分娩的28,925病例进行回顾性分析。排除经产妇、多胎、孕周28周、胎死宫内、合并危及母婴生命并发症共5,654例后,余初产单胎妊娠活产23,271例,将其中具有下列单项九个因素之一的产妇共9,027例作为最终研究对象,包括高龄初产(advanced maternal age, AMA)、早产、子痫前期、妊娠期糖尿病(gestational diabetes mellitus, GDM)、妊娠合并轻度内外科系统并发症、大于胎龄儿(large for gestational age, LGA)、小于胎龄儿(small for gestational age, SGA)、脐绕颈1周、脐绕颈≥2周,分析这些轻度危险因素各自与CD的相关性,研究具有单项轻度危险因素的妊娠分娩方式对妊娠结局的影响。 结果1、校正母亲学历、孕前体重指数(body mass index, BMI)%产前保健次数混杂因素后,AMA (OR2.86,95%CI2.51-3.25,P0.001)、子痫前期(OR1.87,95%CI1.55-2.26,P0.001)、妊娠合并轻度内外科系统并发症(OR1.12,95%CI1.02-1.23, P=0.02)、LGA (OR2.46,95%CI2.18-2.78,P0.001)、脐绕颈≥2周(OR2.58,95%CI2.07-3.21, P0.001)均是行CD的危险因素；而早产(OR0.82,95%CI0.70-0.96,P=0.014)、SGA(OR0.73,95%CI0.65-0.82,P0.001)则为CD的保护性因素；GDM(P=0.1)、脐绕颈1周(P=0.991)与分娩方式无相关性。2、AMA、脐绕颈1周、脐绕颈≥2周,在CD组与阴道分娩(vaginal delivery,VD)组妊娠不良结局的发生率均无统计学差异(P0.05)；3、CD组下列妊娠不良结局的发生率显著高于VD组：①、早产组产后大出血发生率(1.7%vs0,P=0.019)、输血率(2.84%vs0.21%,χ2=7.21,P=0.007)及新生儿呼吸系统并发症率(19.89%vs12.42%,)χ2=5.83,P=0.016)；②、子痫前期组新生儿转NICU率(neonatalintensive care unit, NICU)(25.20%vs9.22%,%2=12.21, P0.001);③、GDM组新生儿转NICU率(17.06%vs10.70%, χ2=12-02,P=0-001);④、妊娠合并轻度内外科系统并发症组母亲转ICU率(0.73%vs0.06%,x2=6.05,P=0.014)、Apgar Score 7@5min(0.73%vs0.06%,x2=6.05,P=0.014)、新生儿转NICU率(15.16%vs8.03%, x2=29, P0.001)。⑤、SGA组新生儿转NICU率(30.03%vs14.09%,χ2=38.931,P0.001)、高胆红素血症需蓝光治疗率(9.56%vs5.32%,χ2=6.80,P=0.009)及新生儿败血症发生率(6.48%vs3.76%,χ2=3.97,P=0.046)。 结论尽管具有某些轻度危险因素的妊娠增加了剖宫产风险,但在良好的医疗水平 下阴道分娩仍能获得良好的妊娠结局。
[Abstract]:Objective to study the effect of delivery mode on the outcome of single pregnancy primipara with a single mild risk factor, and to provide scientific basis for reducing the rate of cesarean section (cesarean delivery, CD) of mild risk pregnancy. Methods 28925 cases of obstetrical delivery in the first affiliated Hospital of Kunming Medical University from January 1, 2005 to December 31, 2013 were retrospectively analyzed. After ruling out 5654 cases of intrauterine death and complications endangering the life of mother and child, 23271 cases of single pregnancy were excluded. 9027 cases of women with one of the following single factors were selected as the final research objects. These include premature delivery of (advanced maternal age, AMA), preeclampsia, gestational diabetes mellitus (gestational diabetes mellitus, GDM),) pregnancy with mild complications of internal and surgical system, (large for gestational age, LGA), greater than gestational age and less (small for gestational age, of gestational age. SGA), umbilical cord around the neck 1 week, umbilical around the neck 鈮，

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