孕41周妊娠结局及引产利弊分析

目的通过对孕41周妊娠结局的分析，了解延期妊娠对胎儿及新生儿的影响；孕41周后引产的利弊。方法采用回顾性研究，对2002年7月至2004年12月足月无合并症初产妇资料进行分析，共计2903例，其中461例为延期妊娠（41～41舶周）。结果延期妊娠组剖宫产率为48.81％，胎儿窘迫发生率为43．38％。明显高于其它孕周组（P〈0．01），新生儿窒息发生率为1．08％，高于孕周38周组，低于其它组。但无统计学意义（P〉0．05）。延期妊娠引产组剖官产率为52．28％，自然临产组为28．36％，引产组明显高于自然临产组（P〈0．01），胎儿窘迫和新生儿窒息发生率分别为42．89％和1．02％，34．33％和1．49％，均无统计学意义（P〉0．05）。引产组宫颈Bishop评分低于5分者，剖宫产率为65．6％，高于自然临产组和评分6分及以上组（P〈0．05），与评分5分相比无统计学意义（P〉0．05）。孕41～41^＋3周分娩者与孕41^＋4～41^＋6周分娩者结局无明显差别。结论妊娠满41周后胎儿有官内缺氧的危险，应适时终止。宫颈条件不成熟者引产。难产危险性增加。刚满41周宫颈条件不成熟、又无迫切原因需要立即终止妊娠者，可严密观察下等待2～3d至41^＋4周再引产是可行的。

Pregnant outcome in women over 41 gestational weeks

Objective To study the pregnant outcome of those women who were over 41 gesta tional weeks. Methods A retrospective study, including 2903 normal nulliparous women who had delivered between July 1,2002, and December 31,2004, was conducted. Totally, 461 cases of prolonged pregnancies were included. The rates of cesarean delivery, fetal distress, and neonatal asphyxia were compared between those over 41 weeks and the others. Results The rates of cesarean delivery (48. 81%) and fetal distress (43. 38%) in prolonged pregnant group were significantly increased than those of the others women(P<0. 01), while the rate of the neonatal asphyxiad. 08%) showed no difference. A higher rate of cesarean delivery was found in the prolonged pregnant group than that of the spontaneous onset of labor in the induced women(P<0. 01). The lower the Bishop score, the higher the rate of cesarean delivery. Conclusions Pregnancy over 41 weeks might increase the risk of intrauterine hypoxia and should be delivered. But for those wpmen at 41 weeks, induction with unfavorable cervix would result in dystocia, so it might be appropriate to wait for another 2-3 days to be induced if with unfavorable cervix or without urgent indication for induction.