本文選題：再次剖宮產(chǎn) + 擇期剖宮產(chǎn)�。� 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：分析不同孕周行擇期再次剖宮產(chǎn)的母兒圍產(chǎn)期結(jié)局，探討再次剖宮產(chǎn)的最佳終止妊娠時(shí)機(jī)。 方法：回顧性收集重慶醫(yī)科大學(xué)附屬第一醫(yī)院（簡(jiǎn)稱本院）產(chǎn)科電子病歷系統(tǒng)記錄的自2011年6月至2013年6月住院分娩的所有產(chǎn)婦的資料。選擇妊娠滿37周無妊娠合并癥或基礎(chǔ)疾病的宮內(nèi)單活胎、擇期行再次剖宮產(chǎn)的孕婦為研究對(duì)象，并根據(jù)不同孕周進(jìn)行分組。采用單因素方差分析或χ2檢驗(yàn)比較不同孕周終止妊娠的孕產(chǎn)婦的一般情況和妊娠結(jié)局以及新生兒不良事件的發(fā)生情況。 結(jié)果：共579例足月行再次剖宮產(chǎn)的產(chǎn)婦納入本研究，其中妊娠39周前手術(shù)者與39~周手術(shù)者的比例分別為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），無產(chǎn)婦、胎兒或新生兒死亡。妊娠37~周、38~周、39~周、40~周和≥41周分娩的產(chǎn)婦2次剖宮產(chǎn)間隔時(shí)間差異無統(tǒng)計(jì)學(xué)意義（P0.05），住院時(shí)間差異有統(tǒng)計(jì)學(xué)意義。不同孕周分娩的產(chǎn)婦的終止妊娠時(shí)體質(zhì)量指數(shù)、胎盤胎膜殘留、術(shù)中術(shù)后出血、胎膜早破、轉(zhuǎn)重癥監(jiān)護(hù)病房和子宮切除等指標(biāo)差異均無統(tǒng)計(jì)學(xué)意義（P值均0.05）。5組分娩新生兒的出生體重和出生身長(zhǎng)差異均有統(tǒng)計(jì)學(xué)意義，1min和5min Apgar評(píng)分差異亦有統(tǒng)計(jì)學(xué)意義。5組新生兒不良事件發(fā)生率包括轉(zhuǎn)新生兒重癥監(jiān)護(hù)病房（Neonatal intensive care unit，NICU）、接受心肺復(fù)蘇或呼吸機(jī)治療、窒息和住NICU≥5d的比例差異有統(tǒng)計(jì)學(xué)意義。以妊娠39~周終止妊娠為標(biāo)準(zhǔn)，妊娠37~周、38~周行再次剖宮產(chǎn)所分娩的新生兒不良事件的發(fā)生風(fēng)險(xiǎn)（OR值及其95%CI）分別為1.1（1.0~2.1）和1.3（0.9~1.9）。 結(jié)論：提前終止妊娠并未降低孕產(chǎn)婦不良妊娠結(jié)局的發(fā)生率，但卻增加新生兒呼吸系統(tǒng)疾病等不良事件的發(fā)生風(fēng)險(xiǎn)。而本院妊娠39周前行擇期再次剖宮產(chǎn)的比例較高，因此，，在兼顧孕婦安全的前提下，為減少新生兒不良事件的發(fā)生風(fēng)險(xiǎn)，建議將妊娠39~39+6周作為擇期再次剖宮產(chǎn)的最佳時(shí)機(jī)。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R719.82

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