巨大胎儿相关因素及预后340例临床分析

新生儿出生体重（NBW）≥4000g称为巨大胎儿,NBW≥4500g称为特大胎儿,属高危妊娠。近年来巨大胎儿发生率逐渐增高,巨大胎儿分娩并发症及围生儿病发率明显增加。现对我院住院分娩的340例巨大胎儿进行回顾性临床分析,探讨诊断巨大胎儿的相关因素,分析如下。     

非糖尿病性巨大胎儿368例临床分析

目的 分析非糖尿病性巨大胎儿的相关危险因素,为临床预测巨大胎儿及选择恰当的分娩方式提供依据.方法 回顾性分析南京军区南京总医院2006年1月至2007年12月期间出生的368例非糖尿病性巨大胎儿的临床资料,分析孕母的年龄、身高、基础体重、孕周、孕产次、分娩时体重、孕期增重、宫高、腹围及胎儿的股骨长、双顶径、分娩方式等,并与新生儿出生体重进行相关及回归分析.结果 非糖尿病性巨大胎儿的发生率为13.23%(368/2781).基础体重、分娩时体重、孕期增重、宫高、腹围、双顶径、股骨长、宫高+腹围、双顶径+股骨长是产前诊断非糖尿病性巨大胎儿的相关因素,而宫高及双顶径+股骨长相关性最为显著.非糖尿病性巨大胎儿与正常体重儿分娩方式差异无统计学意义.结论 结合宫高及双顶径+股骨长能够提高非糖尿病性巨大胎儿的产前预测率.巨大胎儿并不是剖宫产的绝对指征.     

巨大胎儿与临床关系

文献报道巨大胎儿的定义是出生体重≥4000g,其发生率为6%～10%。巨大儿分娩时常有下列问题:巨大胎儿的认别,分娩方式的选择,阴道分娩时的滞产、肩难产,母儿产伤,使母儿发病率及死亡率增高。该院1987年1月至12月共有孕妇100 746例,分娩婴儿101 931人,其中8 591例达到出生体重≥4 000g的巨大胎儿标准。     

505例巨大胎儿分析

目的 探讨巨大胎儿的产前诊断及分娩方式,降低母儿并发症。方法 回顾分析５０５例巨大胎儿诊断、分娩方式及并发症,并与单胎正常体重儿分娩情况进行比较。结果 巨大胎儿中双顶径（ＢＰＤ）＋胎骨长度（ＦＬ）〉１６．５ｃｍ者占８８．４６％,剖宫产组较阴道分娩组新生儿窒息率及产伤机会均明显降低,巨大胎儿与正常体重儿相比难产率明显升高。结论 ＢＰＤ＋ＦＬ〉１６．５ｃｍ可做为产前诊断巨大胎儿的一项可靠指标,对巨大胎     

395例巨大儿临床分析

巨大儿是产科常见的胎儿并发症之一 ,是难产、新生儿产伤的高危因素 ,近年来有明显增加趋势 ,是产科医生面临的又一重要问题。本文对 395例巨大儿做回顾性分析 ,探讨巨大儿产前预测及分娩方式 ,减少母儿并发症。资料与方法1 一般资料 :1 996年 1月～ 2 0 0 0年 1 2月 5年间在我院分娩的骨盆、身高正常的产妇共 4 72 9例 ,其中巨大胎儿395例 (出生体重≥ 4 0 0 0g) ,发生率为 8 4 % ;正常体重儿4 334例 (出生体重≥ 2 5 0 0g ,4 0 0 0g) ,发生率为 91 6 % ;孕妇年龄最小 2 3岁 ,最大 39岁 ,2 5～ 34岁占 82 2 % ;初产妇 32 2例 ,占 81 5 …     

巨大儿产科处理合理性探讨-附190例临床分析

近年来,随着医疗纠纷的增多,使很多产科医生在决定巨大胎儿分娩方式时,由于担心阴道分娩发生新生儿副损伤,从而大大放宽了剖宫产指征,甚至有的将产前估计可能为巨大胎儿,作为剖宫产的绝对指征。本文对我院190例巨大儿的产前诊断、分娩方式与分娩结局作回顾性分析,旨在探讨巨大胎儿处理的合理性,以减少因处理不当对母婴产生的不良影响。1资料与方法1.1一般资料1999年6月至2003年6月,我院共分娩1750例,巨大儿(体重>4000 g)190例(10.86%),其中体重≥4500 g 4例。产妇年龄22~36岁,初产妇154例,经产妇36例。190例巨大儿产妇骨盆外测量均在正常范…     

烟台市30年巨大胎儿发生率及其相关因素的变化

目的　探讨巨大胎儿发生率的变化趋势以及发生的相关因素。方法　以 1970年 1月至 1999年 12月分娩的 84 883例新生儿为研究对象 ,分别统计巨大胎儿 (体重≥ 4 0 0 0g)的发生率、平均出生体重、特大胎儿 (体重≥ 4 5 0 0g)所占比例 ,孕龄分布、剖宫产及阴道手术助产率、发生巨大胎儿的相关因素。结果　 1970年至 1979年、1980年至 1989年及 1990年至 1999年 3个阶段的巨大胎儿发生率分别为 2 6 %、6 9%和 13 2 % (P <0 0 1) ;剖宫产率分别为 2 3%、2 8 9%和 4 5 3% (P <0 0 1) ;阴道手术助产率分别为 14 7%、35 6 %、4 8% ,经阴道分娩肩难产发生率为 4 3%、5 0 %、1 7% ,而剖宫产孕妇无此并发症发生。特大胎儿所占比例分别为 9 4 %、11 2 %、16 2 % (P <0 0 1)。 3个阶段巨大胎儿平均出生体重分别为 (42 2 0± 2 5 0 )g、(42 2 3± 14 6 )g和 (42 5 3± 2 5 0 )g。孕妇的身高、体重、腹围、糖尿病性巨大胎儿的变化均有统计学意义。结论　 30年来 ,烟台市区的巨大胎儿发生率、平均出生体重、特大胎儿所占比例及剖宫产率呈增加趋势。巨大胎儿的发生与孕妇的身高、营养状况、体重、妊娠期糖尿病、孕周等因素有关。巨大胎儿的分娩方式以剖宫产为相对安全     

肥胖妇女的妊娠

肥胖孕妇发病率约6～10%。其孕期并发症如高血压、糖尿病、过期妊娠等均有所增加。超重孕妇易分娩巨大儿,临产后因头盆不称、产程延长常需催产或手术分娩,使胎儿宫内窘迫、新生儿窒息、胎粪吸入、新生儿产伤的发生率增高。新生儿尚可出现一时性无症状低血糖。对肥胖孕妇应加强产前系统管理及营养指导,同时在处理分娩及新生儿监护等方面提出需要注意的问题。     

巨大胎儿105例相关因素及分娩结局临床分析

胎儿出生体重≥4000g称巨大儿，属高危妊娠。近几年来随着人们生活水平的提高及计划生育的开展，巨大儿的发生率逐渐增高，巨大胎儿分娩并发症及围生儿病死率明显增加。现对我院近年来巨大胎儿相关因素、分娩结局进行回顾性分析，以便正确处理产程，选择恰当的分娩方式，确保母婴安全，报告如下。     

孕前肥胖及孕期体重增长过度与妊娠期并发症及分娩结局的关系探讨

目的:探讨孕前肥胖、孕期体重增长过度孕妇妊娠期并发症的发生以及其分娩结局的关系。方法:测量2236例足月单胎初产妇孕前的身高、体重和孕期体重增长情况,计算孕前体重指数,并分别观察肥胖孕妇的妊娠期并发症、分娩方式、产程以及产后出血、新生儿窒息、巨大儿发生情况。结果:①孕前肥胖及孕期体重增长过度的孕妇妊娠期糖尿病、妊娠期高血压疾病以及早产的发生率与对照组比较差异有显著性;②孕前肥胖及孕期体重增长过度孕妇总产程、产程异常发生率、剖宫产率、产钳助产率、巨大儿和新生儿窒息的发生率以及围生儿死亡率与对照组比较差异有显著性或非常显著性。结论:孕前肥胖及孕期体重增长过度对孕产妇和新生儿均产生不利影响,增加了妊娠期、分娩期并发症和增高了难产发生率。     

妊娠期肝内胆汁淤积症的临床干预对围生儿预后的影响

目的:探讨妊娠期肝内胆汁淤积症(ICP)的临床干预对围生儿预后的影响。方法:分析比较70例ICP患者干预治疗前后,与同期未作过任何干预的48例ICP患者的临床症状、肝功能指标及围生儿结局进行比较。结果:观察组治疗后瘙痒评分、血清胆汁酸、总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶等生化指标较治疗前明显下降(P<0.01)。与对照组比较观察组孕周较长,新生儿体重较重,胎儿窘迫、羊水粪染、早产儿、新生儿窒息发生率降低(P<0.01)。但低体重儿、围生儿死亡发生率无明显改变,两者比较无显著差异(P>0.05)。结论:积极正确处理妊娠期肝内胆汁淤积症可明显减轻孕妇的瘙痒症状,降低围生儿的胎儿窘迫、羊水粪染、新生儿窒息等的发生率,提高围生儿的生存质量。     

2005至2011年青岛市某医院巨大儿发生率及其影响因素的调查

目的:用回顾性分析的方法,调查巨大儿发生的影响因素,为减少巨大儿的发生和孕期保健提供依据。方法:以2005年1月1日至2011年12月31日在解放军第401医院妇产科出生的单胎活产新生儿作为研究对象进行回顾性研究,并进行统计学分析。结果:2005～2011年在我院出生的新生儿中,符合研究条件并取得完整资料的共计3691例,其中巨大儿429例,其发生率为11.62%。其中母亲年龄>30岁、孕次≥2次、孕前BMI≥25.0kg/m2、孕周>40周、孕期增重超过标准、妊娠期糖尿病和新生儿为男婴7个因素,是导致巨大儿发生率增高的影响因素。结论:合理调整妊娠年龄、孕次以及孕前BMI,合理搭配孕期膳食,并严格控制糖的摄入,对于降低巨大儿的发生率具有重要意义。     

Fetal macrosomia: mode of delivery

This study was provided among 1847 deliveries from January, 1 to December, 31, 2003. The aim of the study was to examine the correlation between antenatal diagnosis "fetal macrosomia" and the mode of delivery. We found that among the cases with birth weight > or = 4000 g and antenatal diagnosis "fetal macrosomia" the rate of cesarean section was fourfold higher than among the cases without such a diagnosis. There weren't statistically significant correlation between the cases with antenatal diagnosis "fetal macrosomia " and the cases with estimated birth weight < or = 3999g in reference to the mother's age and weight, parity, fundal height and abdominal circumference. There are insignificant differences between both of groups in reference to gestacional age and birth.     

Effects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery

OBJECTIVE: The aim of this study was to examine the effects of a policy of elective cesarean delivery for suspected fetal macrosomia on the incidence of brachial palsy and on the cesarean delivery rate. STUDY DESIGN: We performed a retrospective assessment of a policy that recommends cesarean delivery for macrosomia (fetal weight > or =4500 g). Fetal weight was estimated by palpation, and ultrasonographic weight estimation was carried out whenever macrosomia was suspected. RESULTS: During the 4 years of the study 16,416 deliveries resulted in 133 infants with macrosomia (0.8%). Macrosomia was suspected in 47 cases and confirmed by birth weight in 21 (45%). Antenatal estimation of fetal weight was carried out for 115 of the fetuses with macrosomia (86%). Macrosomia was correctly predicted in 21 of 115 cases (18.3%). Thirteen infants with undiagnosed macrosomia were delivered by emergency cesarean procedures, and 99 were delivered vaginally. Three infants with macrosomia (3%) and 14 infants without macrosomia (0.1%) sustained brachial plexus injury. Our policy prevented at most a single case of brachial palsy, and it contributed 0.16% to our cesarean delivery rate. CONCLUSIONS: A policy of elective cesarean delivery in cases of suspected fetal macrosomia had an insignificant effect on the incidence of brachial plexus injury. Its contribution to the rate of cesarean delivery was also small.     

超声测量胎儿腹围预测新生儿出生体重的研究

目的探讨超声测量胎儿腹围在预测新生儿出生体重和诊断巨大儿中的价值。方法在孕妇分娩前1周超声测量胎儿腹围,追踪胎儿的出生体重,分析胎儿腹围与出生体重的关系。结果(1)共检测1475例单胎孕妇胎儿,胎儿腹围与出生体重呈直线正相关关系,r为0.85(P<0.01)。(2)胎儿腹围<34cm者中无一例巨大儿;胎儿腹围<35cm有1007例,99.7%的新生儿平均出生体重<4000g;胎儿腹围在35～35.9cm有206例,新生儿平均出生体重为(3691±277)g,其中14.6%(30例)的新生儿出生体重≥4000g;胎儿腹围在36～36.9cm有149例,其中51.0%(76例)的新生儿出生体重≥4000g,新生儿平均出生体重为(3957±256)g;胎儿腹围在37～37.9cm有64例,其中84.4%(54例)的新生儿出生体重≥4000g,平均出生体重(4205±250)g;胎儿腹围≥38cm有44例,新生儿平均出生体重≥4000g者为100%(44例),平均出生体重为(4489±267)g。(3)1475例中有811例孕妇行剖宫产术(55.0%),新生儿出生体重为4000～4500g者,剖宫产率为71.4%(125/175),出生体重≥4500g者,剖宫产率为93.8%(30/32),均显著高于新生儿出生体重<4000g的剖宫产率(P<0.01)。结论超声测量胎儿腹围可以预测新生儿出生体重。胎儿腹围与胎儿体重呈高度直线正相关。胎儿腹围<35cm提示发生巨大儿的可能性极低;≥37cm提示巨大儿的可能性大。     

Use of insulin glargine during pregnancy: a case-control pilot study

OBJECTIVE: To determine whether the use of insulin glargine during pregnancy is associated with an increase in the incidence of fetal macrosomia or adverse neonatal outcome. DESIGN: A matched case-control study. SETTING: Women's Centre, John Radcliffe Hospital, Oxford, UK. SAMPLE: Sixty-four pregnant women treated with insulin during their pregnancies, 20 with type I diabetes and 44 with gestational diabetes. METHODS: Two groups of women were compared in matched pairs. A study group of 32 pregnant women with diabetes treated with insulin glargine during their pregnancy and a control group of 32 pregnant women treated with an intermediate-acting human insulin (isophane or insulin zinc suspension) and matched for weight at booking, height, gestation at delivery, parity, fetal sex, duration of insulin use in pregnancy and glycaemic control during the third trimester of pregnancy (glycosylated haemoglobin [HbA(1c)] concentration and mean blood glucose concentration). MAIN OUTCOME MEASURES: Birthweight, centile birthweight, the incidence of fetal macrosomia (birthweight > 90th percentile) and neonatal morbidity in the two study groups. RESULTS: There was no significant difference between the birthweight or centile birthweight of babies born to the women treated with insulin glargine during pregnancy and that of the babies born to those in the control group treated with intermediate-acting human insulin. The overall incidence of fetal macrosomia was 12/32 (37.5%) in the insulin glargine group and 13/32 (40.6%) in the control group. There was no significant difference in neonatal morbidity between the groups. CONCLUSIONS: The results of this pilot study indicate that insulin glargine treatment during pregnancy does not appear to be associated with increased fetal macrosomia or neonatal morbidity.     

糖尿病合并妊娠和妊娠期糖尿病母儿并发症诊治探讨

目的:探讨妊娠合并糖尿病的母婴并发症及诊治。方法:回顾性分析83例糖尿病合并妊娠患者(A组)及90例妊娠期糖尿病患者(B组)的临床资料,并比较其妊娠结局,包括孕产妇并发症(妊娠期高血压疾病、胎膜早破、DKA、早产、羊水过多、胎儿宫内窘迫、剖宫产率、产后出血)及新生儿并发症(巨大儿、新生儿低血糖、胎死宫内、RDS、畸形、窒息)。结果:A组的孕妇并发症除产后出血较B组明显升高;巨大儿、新生儿低血糖、胎死宫内、畸形的发生率明显升高,差异有显著性(P<0.05)。结论:糖尿病合并妊娠对孕妇及胎儿有更大的危害,要加强对其孕前、孕期及孕后的管理。     

Gestational diabetes mellitus increased the risk of adverse neonatal outcomes: A prospective cohort study in Northwest Ethiopia

BackgroundGestational diabetes mellitus is a rising global public health problem that can have short- and long-term sequelae for both mother and offspring. However, there are limited evidences on the effect of gestational diabetes mellitus on adverse neonatal outcomes using the updated international diagnostic criteria on adverse effects on neonatal outcomes. Therefore, this study was aimed to examine the effects of gestational diabetes mellitus on the risk of adverse neonatal outcomes in Ethiopia.MethodsA prospective cohort study was conducted among pregnant women recruited from antenatal clinics and followed through pregnancy to delivery. Gestational diabetes mellitus was diagnosed using a two-hour 75g oral glucose tolerance test strategy with recent criteria. Multivariable log-binomial model was used to identify the effects of gestational diabetes mellitus on the risk of adverse neonatal outcomes which includes macrosomia, low birth weight, large for gestational age, small for gestational age, preterm birth, low Apgar score at the first minute, low Apgar score at fifth minute, and composite adverse neonatal outcome.ResultsAmong pregnant women (n=1027) included in the follow up data on neonatal outcomes were available for 684 (118 newborns of mothers with gestational diabetes mellitus and 566 newborns of women without gestational diabetes mellitus). There was a statistical baseline difference between the two groups by maternal age, dietary diversity status, level of physical activity, and antenatal depression. The incidence of composite adverse neonatal outcome was significantly higher (P<0.001) among newborns from mothers with gestational diabetes mellitus (51.7%) than among newborns from mothers without gestational diabetes mellitus (25.8%). Significantly higher risk of developing adverse neonatal outcomes among newborns from gestational diabetes mellitus mothers was observed for composite adverse neonatal outcome (Adjust Relative Risk (ARR)=1.72; 95% CI: 1.35, 2.19), macrosomia (ARR= 3.81; 95% CI: 1.95, 7.45), large for gestational age (ARR= 2.38; 95% CI: 1.41, 4.03), preterm birth (ARR= 2.03; 95% CI: 1.17, 3.53), low Apgar score at the first minute (ARR= 1.71; 95% CI: 1.02, 2.86), and fifth minute (ARR= 2.14; 95% CI: 1.05, 4.36). However, no significant differences in the risk of low birth weight and small for gestational age by gestational diabetes mellitus status.ConclusionsGestational diabetes mellitus increases the risk of adverse neonatal outcomes particularly macrosomia, large for gestational age, preterm birth, and poor Apgar score. Hence, the role of preventing gestational diabetes mellitus is quite crucial to improve neonatal outcomes.     

巨大儿的产前预测对分娩方式和母儿预后的影响

目的 探讨巨大儿的产前预测对分娩方式和母儿预后的影响。方法 对1994年1月～1998年12月分娩的巨大儿进行回顾性分析,以B超或临床估计胎儿体重是否达到4000g分组,比较巨大儿高危因素、分娩方式、引产效果和母儿并发症。结果 将资料完整的356例分为预测组(188例)和未预测组(168例)。总剖宫产率和选择性剖宫产率预测组均显著高于未预测组(分别为63.30％和42.86％,P<0.05;36.70％和16.07％,P<0.05);预测组引产率低于未预测组(51.60％和66.67％,P<0.05),引产后阴道分娩成功率两组差异无显著性(P>0.05)。260例阴道试产病例中,预测组(n=119)与未预测组(n=141)相比,胎儿宫内窘迫率(26.89％和39.72％)、新生儿窒息率(8.40％和17.02％)、宫缩乏力性产后出血发生率(0.84％和5.67％)均较低(P<0.05),肩难产及新生儿产伤差异无显著性(P>0.05)。结论 重视巨大儿的产前预测,遵循个体化原则决定分娩方式,通过加强监护,有效减少某些母儿并发症。