早产危险因素的研究

目的研究早产的危险因素，为临床进行早产危险人群的筛查提供依据。 方法回顾性分析广州医学院第三附属医院2008年1月至2009年12月间收治的724例(早产组)早产病例资料，其中自发性早产病例427例，医源性早产297例；选取同期足月分娩患者500例(对照组)进行对照研究，采用χ²检验和logistic回归分析，筛选出早产的高危因素。 结果(1)2008年1月至2009年12月分娩总数6109例，早产724例，早产发生率11.85%，其中自发性早产占59%，医源性早产占41%。(2)自发性早产的危险因素是胎膜早破71.19%(304/427)、多胎妊娠21.55% (92/427)、臀位22.95%(98/427)、子宫畸形3.04%(13/427)、宫颈机能不全0.70%(3/427)。(3)医源性早产的危险因素是子痫前期41.08%(122/297)、妊娠合并内外科疾病29.63% (88/297)、多胎妊娠27.61%(82/297)、胎盘因素26.60%(79/297)、妊娠期糖尿病23.57%(70/297)。(4)早产的高危因素为经产(OR＝4.428)、胎膜早破(OR＝5.149)、子痫前期(OR＝2.637)、多胎妊娠(OR＝13.958)、前置胎盘(OR＝14.586)、妊娠合并内外科疾病(OR＝2.677)、妊娠期糖尿病(OR＝3.719)、胎儿生长受限(OR＝14.378)、臀位(OR＝3.663)、体外受精-胚胎移植妊娠(OR＝5.658)。 结论应控制早产高危因素，避免或延迟早产的发生，从而改善母婴预后。

Investigation of risk factors in premature delivery

ObjectiveTo investigate the risk factors in premature delivery and provid evidence for screening population in high risk of premature delivery. MethodsA retrospective study of 724 pregnant women with premature delivery was carried out in the Third Affiliated Hospital of Guangzhou Medical University from June 2008 to December 2009, including 427 patients with spontaneous preterm birth and 297 patients with iatrogenic preterm birth. Five hundred patients were randomly selected by delivered at term as the control ground. Risk factors of premature delivery were analyzed with χ² test and logistic regression analysis. Results(1) Incidence rate of premature delivery was 11.85%, including 59% spontaneous premature delivery and 41% iatrogenic premature delivery. (2) The risk factors of spontaneous premature delivery were premature rupture of membranes (71.19%, 304/427), multiple pregnancy (21.55%, 92/427), breech presentation (22.95%, 98/427), uterine malformation (3.04%, 13/427)and incompetence of cervical (0.70%, 3/427). (3) The risk factors of iatrogenic premature delivery were preeclampsia (41.08%, 122/297), pregnancy with medical and surgical diseases (29.63%, 88/297), multiple pregnancy (27.61%, 82/297), placenta factors (26.60%, 79/297), and gestational diabetes mellitus(23.57%, 70/297). (4) The risk factors of premature delivery were multiparity(OR=4.428), premature rupture of membranes(OR=5.149), preeclampsia(OR=2.637), multiple pregnancy(OR=13.958), placenta praevia(OR=14.586), pregnancy with medical and surgical diseases(OR=2.677), gestational diabetes mellitus(OR=3.719), fetal growth restriction(OR=14.378), breech presentation(OR=3.663)and IVF-ET(OR=5.658). ConclusionIt is necessary to prevent the risk factors of premature delivery and avoid or delay the occurrence of premature delivery in order to improve the maternal and neonatal outcomes.