妊娠期糖尿病孕足月引产的临床研究

目的探讨足月引产对妊娠期糖尿病(gestational diabetes mellitus,GDM)母儿结局的影响。方法选择苏州市立医院本部产科2014年10月至2015年5月收治的孕足月GDM孕妇414例,根据是否自然临产和实施干预分为自然临产组和引产组,自然临产组234例,引产组180例,其中普贝生引产52例,水囊引产13例,人工破膜+催产素静滴引产86例,自然破膜+催产素静滴引产29例。分别对两组孕妇的一般情况、分娩方式、新生儿窒息率等临床资料进行回顾性分析。结果 1引产组的阴道分娩率(77.8%)明显低于自然临产组(95.3%),(P0.05)。2引产组及自然临产组的总产程分别为(6.99±3.86)h和(7.55±3.41)h,羊水III度污染发生率为2.8%(5/180)和2.6%(6/234)、新生儿窒息率为1.7%(3/180)和1.3%(3/234),差异均无统计学意义(P0.05)。3 4种引产方法在产后出血量及阴道分娩率方面,差异有统计学意义(P0.05);阴道分娩率由高至低依次为:人工破膜+催产素静滴组(84.88%)、普贝生组(80.77%)、自然破膜+催产素静滴组(62.07%)、水囊组(53.85%)。4种引产方式剖宫产指征的构成比差异无统计学意义(P0.05)。结论引产增加了孕足月GDM患者的剖宫产率,同时并没有降低新生儿窒息率,故有必要对GDM孕妇的引产采用个体化的治疗,选择合适的引产时机及引产方式。

Clinical study of induced labor in patients with gestational diabetes mellitus

Objective To study the influence of induced labor on maternal-neonatal outcomes of patients with gestational diabetes mellitus( GDM) . Methods Data of 414 pregnant women diagnosed with GDM at Suzhou Municipal Hospital from Oct 2014 to May 2015 were reviewed, including 234 women undergoing spontaneous labor and 180 women undergoing induced labor. The induced methods included vaginal dinoprostone(52 cases), foley catheter(13 cases), artifical rupture of membrane combined with oxytocin(86 cases) and natural rupture of membrane combined with oxytocin ( 29 cases ) . The maternal general situation, delivery method and neonatal asphyxia associated with induced deliveries or spontaneous deliveries were retrospectively analyzed. Results ① The vaginal delivery rate in the induced group ( 77. 8%) was significantly lower than that in spontaneous group ( P<0. 05 ) . ② No significant difference was observed between induced group and spontaneous group in the following puerperal complications:the total stage of labor (6. 99 ± 3. 86h vs 7. 55 ± 3. 41h), severe amniotic fluid contamination(2. 8 %, 5/180 vs 2. 6 %, 6/234 respectively) and neonatal asphyxia(1. 7 %, 3/180 vs 1. 3 %, 3/234) (P>0. 05).③ There was significant difference in the postpartum hemorrhage volume and vaginal delivery rate among the four induced methods. The rate of vaginal delivery from high to low was artificial rupture of membrane combined with oxytocin(84. 88%), vaginal dinoprostone(80. 77 %), natural rupture of membrane combined with oxytocin (62. 07 %), and foley catheter(53. 85%). There was no difference in the constituent ratio of cesarean section among the four induced methods. Conclusions Induced labor increases the rate of casarean section in patients with GDM, but does not reduce the rate of neonatal asphyxia, so there’ s need to explore the appropriate induced time and mode.