發(fā)布時(shí)間：2019-02-16 20:24

【摘要】：目的研究具有單項(xiàng)輕度危險(xiǎn)因素的單胎妊娠初產(chǎn)婦,分娩方式對(duì)妊娠結(jié)局的影響,為降低輕度危險(xiǎn)妊娠剖宮產(chǎn)(cesarean delivery, CD)率提供科學(xué)依據(jù)。 方法對(duì)2005年1月1日至2013年12月31日九年間在昆明醫(yī)科大學(xué)第一附屬醫(yī)院產(chǎn)科分娩的28,925病例進(jìn)行回顧性分析。排除經(jīng)產(chǎn)婦、多胎、孕周28周、胎死宮內(nèi)、合并危及母嬰生命并發(fā)癥共5,654例后,余初產(chǎn)單胎妊娠活產(chǎn)23,271例,將其中具有下列單項(xiàng)九個(gè)因素之一的產(chǎn)婦共9,027例作為最終研究對(duì)象,包括高齡初產(chǎn)(advanced maternal age, AMA)、早產(chǎn)、子癇前期、妊娠期糖尿病(gestational diabetes mellitus, GDM)、妊娠合并輕度內(nèi)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(xiǎn)因素各自與CD的相關(guān)性,研究具有單項(xiàng)輕度危險(xiǎn)因素的妊娠分娩方式對(duì)妊娠結(jié)局的影響。 結(jié)果1、校正母親學(xué)歷、孕前體重指數(shù)(body mass index, BMI)%產(chǎn)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(nèi)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(xiǎn)因素；而早產(chǎn)(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(hù)性因素；GDM(P=0.1)、臍繞頸1周(P=0.991)與分娩方式無(wú)相關(guān)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(jié)局的發(fā)生率均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；3、CD組下列妊娠不良結(jié)局的發(fā)生率顯著高于VD組：①、早產(chǎn)組產(chǎn)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(zhuǎn)NICU率(neonatalintensive care unit, NICU)(25.20%vs9.22%,%2=12.21, P0.001);③、GDM組新生兒轉(zhuǎn)NICU率(17.06%vs10.70%, χ2=12-02,P=0-001);④、妊娠合并輕度內(nèi)外科系統(tǒng)并發(fā)癥組母親轉(zhuǎn)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(zhuǎn)NICU率(15.16%vs8.03%, x2=29, P0.001)。⑤、SGA組新生兒轉(zhuǎn)NICU率(30.03%vs14.09%,χ2=38.931,P0.001)、高膽紅素血癥需藍(lán)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(jié)論盡管具有某些輕度危險(xiǎn)因素的妊娠增加了剖宮產(chǎn)風(fēng)險(xiǎn),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(jié)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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