【摘要】：目的研究具有單項輕度危險因素的單胎妊娠初產婦,分娩方式對妊娠結局的影響,為降低輕度危險妊娠剖宮產(cesarean delivery, CD)率提供科學依據(jù)。 方法對2005年1月1日至2013年12月31日九年間在昆明醫(yī)科大學第一附屬醫(yī)院產科分娩的28,925病例進行回顧性分析。排除經產婦、多胎、孕周28周、胎死宮內、合并危及母嬰生命并發(fā)癥共5,654例后,余初產單胎妊娠活產23,271例,將其中具有下列單項九個因素之一的產婦共9,027例作為最終研究對象,包括高齡初產(advanced maternal age, AMA)、早產、子癇前期、妊娠期糖尿病(gestational diabetes mellitus, GDM)、妊娠合并輕度內外科系統(tǒng)并發(fā)癥、大于胎齡兒(large for gestational age, LGA)、小于胎齡兒(small for gestational age, SGA)、臍繞頸1周、臍繞頸≥2周,分析這些輕度危險因素各自與CD的相關性,研究具有單項輕度危險因素的妊娠分娩方式對妊娠結局的影響。 結果1、校正母親學歷、孕前體重指數(shù)(body mass index, BMI)%產前保健次數(shù)混雜因素后,AMA (OR2.86,95%CI2.51-3.25,P0.001)、子癇前期(OR1.87,95%CI1.55-2.26,P0.001)、妊娠合并輕度內外科系統(tǒng)并發(fā)癥(OR1.12,95%CI1.02-1.23, P=0.02)、LGA (OR2.46,95%CI2.18-2.78,P0.001)、臍繞頸≥2周(OR2.58,95%CI2.07-3.21, P0.001)均是行CD的危險因素；而早產(OR0.82,95%CI0.70-0.96,P=0.014)、SGA(OR0.73,95%CI0.65-0.82,P0.001)則為CD的保護性因素；GDM(P=0.1)、臍繞頸1周(P=0.991)與分娩方式無相關性。2、AMA、臍繞頸1周、臍繞頸≥2周,在CD組與陰道分娩(vaginal delivery,VD)組妊娠不良結局的發(fā)生率均無統(tǒng)計學差異(P0.05)；3、CD組下列妊娠不良結局的發(fā)生率顯著高于VD組：①、早產組產后大出血發(fā)生率(1.7%vs0,P=0.019)、輸血率(2.84%vs0.21%,χ2=7.21,P=0.007)及新生兒呼吸系統(tǒng)并發(fā)癥率(19.89%vs12.42%,)χ2=5.83,P=0.016)；②、子癇前期組新生兒轉NICU率(neonatalintensive care unit, NICU)(25.20%vs9.22%,%2=12.21, P0.001);③、GDM組新生兒轉NICU率(17.06%vs10.70%, χ2=12-02,P=0-001);④、妊娠合并輕度內外科系統(tǒng)并發(fā)癥組母親轉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)、新生兒轉NICU率(15.16%vs8.03%, x2=29, P0.001)。⑤、SGA組新生兒轉NICU率(30.03%vs14.09%,χ2=38.931,P0.001)、高膽紅素血癥需藍光治療率(9.56%vs5.32%,χ2=6.80,P=0.009)及新生兒敗血癥發(fā)生率(6.48%vs3.76%,χ2=3.97,P=0.046)。 結論盡管具有某些輕度危險因素的妊娠增加了剖宮產風險,但在良好的醫(yī)療水平 下陰道分娩仍能獲得良好的妊娠結局。
[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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