不同孕周非治疗性早产患者的高危因素及妊娠结局分析

目的探讨不同孕周非治疗性早产患者的高危因素和母儿不良结局。 方法采用回顾性研究方法对2012年1月至2014年12月就诊于广州医科大学附属第三医院224例非治疗性早产患者资料进行分析，根据不同孕周分成4组：A组：28～29^＋6周(38例)，B组：30～31^＋6周(32例)，C组：32～33^＋6周(42例)，D组：34～36^＋6周(112例)；分析4组患者的高危因素、产妇及新生儿的不良结局。 结果224例非治疗性早产患者发生早产的高危因素分别为胎膜早破147例(65.6%)、不良孕产史128例(57.1%)、先兆早产病史115例(51.3%)、体外受精-胚胎移植术妊娠87例(38.8%)、未规律产检53例(23.7%)、双胎妊娠25例(11.2%)。4组总产程时间分别为(4.9±3.5) h，(7.6±3.8) h，(6.7±2.9) h，(6.8±2.9) h，A组与其他3组比较，Q＝1.762，2.719和1.847 (P值均<0.05)。4组急产发生率分别为44.7% (17例)，9.4% (3例)，16.7% (7例)，14.3% (16例)，A组与其他3组比较，Q＝21.648，8.207和9.783(P值均<0.05)。4组新生儿窒息发生率分别为31.6% (12例), 12.5% (4例)，7.1% (3例)，6.3% (7例)，A组与其他3组比较，Q＝4.591，15.345和10.834(P值均<0.05)。4组新生儿1 min Apgar评分分别为(7.7±3.2)分，(9.1±2.4)分，(9.4±1.2)分，(9.4±1.1)分，A组与其他3组比较，Q＝2.528，3.281和2.562(P值均<0.05)。4组新生儿出生体重分别为(1 555.9±470.9) g，(1 659.3±342.2) g，(1 990.8±306.5) g，(2 515.0±473.4) g，各组间差异的两两比较均存在统计学意义(P<0.01)。 结论胎膜早破是非治疗性早产发生的最常见的高危因素，要重视28～29^＋6周早产高危患者的管理，并应警惕这些孕妇和新生儿不良结局的发生。

Analysis of risk factors and pregnancy outcomes of non-therapeutic premature birth pregnant patients at different gestational ages

ObjectiveTo investigate the risk factors and the adverse pregnancy outcomes of non-therapeutic premature birth pregnant patients at different gestational ages. MethodsThe clinical data of 224 non-therapeutic preterm birth patients, admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 2012 to December 2014, were retrospectively analyzed. Based on the gestational age, research participants were divided into 4 groups: group A: 28-29^{+ 6} weeks (38 cases), group B: 30-31^{+ 6} weeks (32 cases), group C: 32-33^{+ 6} weeks (42 cases) and group D: 34-36^{+ 6} weeks (112 cases). The clinical data included risk factors, poor outcomes of mothers and newborns. ResultsCommon risk factors of the 224 patients included premature rupture of membranes (147 cases, 65.6%), adverse history of pregnancy and parity (128 cases, 57.1%), history of threatened premature labor (115 cases, 51.3%), in vitro fertilization and embryotransfer pregnancy (87 cases, 38.8%), irregular antenatal examination (53 cases, 23.7%), and twin pregnancy (25 cases, 11.2%). The total duration of labor in the 4 groups were (4.9±3.5) hours, (7.6±3.8) hours, (6.7±2.9) hours and (6.8±2.9) hours, respectively; there were significant differences between group A and the other 3 groups(Q=1.762, 2.719, 1.847, all P value<0.05). The rate of emergency labor in the 4 groups were 44.7% (17 cases), 9.4% (3 cases), 16.7% (7 cases), 14.3% (16 cases), respectively; there were significant differences between group A and the other 3 groups (Q=21.648, 8.207 and 9.783, all P value<0.05). The incidence rate of neonatal asphyxia in the 4 groups were 31.6% (12 cases), 12.5% (4 cases), 7.1% (3 cases) and 6.3% (7 cases), respectively; there were significant differences between group A and other 3 groups (Q=4.591, 15.345 and 10.834, all P value<0.05). One-minute Apgar score of the 4 groups were (7.7±3.2) score, (9.1±2.4) score, (9.4±1.2) score, (9.4±1.1) score, respectively; there were significant differences between group A and other 3 groups (Q=2.528, 3.281 and 2.562, all P value<0.05). The birth weights of the 4 groups were (1 555.9±470.9) g, (1 659.3±342.2) g, (1 990.8±306.5) g and (2 515.0±473.4) g, respectively; there were significance differences in the groups, all P value<0.05. ConclusionsPremature rupture of membrane was the most common risk factor of non-therapeutic preterm birth. For the preterm birth patients with gestational age from 28 to 29^{+ 6} weeks, we should pay attention to the management, in order to prevent adverse outcomes of the mothers and newborns.