有关巨大儿相关围产因素变化的探讨

目的:探讨近年来巨大儿相关围产因素的变化。方法:回顾性分析我院分娩巨大儿的完整在案病历共435例,按年份分为1984年组、1994年组及2004年组。比较及分析3组巨大儿的发生率、产科相关因素、剖宫产率及剖宫产指征的变化情况。结果:3年间巨大儿的发生率分别为4.57%、6.06%及9.91%(P<0.05)。巨大儿孕妇的剖宫产率分别为56.55%、61.33%及84.38%(P<0.01)。3组巨大儿孕妇择期及临产后剖宫产率:1984年组与1994年组比较均无显著性差异(P>0.05)。1984年组及1994年组各与2004年组比较均有显著性差异(P<0.05)。3组剖宫产手术指征的变化:无论是临产后或择期手术以家属要求为指征的剖宫产率均呈上升趋势(P<0.001)。3组比较巨大儿合并过期妊娠的发生率分别为11.9%、9.3%及2.1%(P<0.001)。而巨大儿合并经产妇的发生率则分别为8.9%、13.3%及18.8%(P<0.01)。结论:对存在可能发生巨大胎儿倾向因素的孕妇适当采取一些有效的措施,尽量减少巨大胎儿的发生是降低剖宫产率及保障母婴安全的一项重要措施。

Probe into perinatal period related factors of macrosomia

Objective:To investigate the changes of the relevant factors during perinatal period in macrosomia in the past years.Methods:Retrospective analysis was conducted in the total of 435 complete macrosomia cases in this hospital.The cases were divided into 3 groups according to the year of delivery,which are group 1984,group 1994 and group 2004 to compare and analyze the incidence rate,maternity factor,uterine-incision delivery rate and the indication of uterine-incision delivery in these 3 groups of macrosomia.Results:The incidence rate of macrosomia in 3 groups was 4.57%,6.06% and 9.91%(P<0.05).The uterine-incision delivery rate in 3 groups was 56.55%,61.33% and 84.38%(P<0.01).There was no significant difference between group 1984 and group 1994(P>0.05)on the uterine-incision delivery rate of selected delivery and parturient,but there was obvious difference between group 2004 and group 1984 and group 1994(P<0.05).The indication change condition of uterine-incision delivery of these 3 groups showed that delivery date uterine-incision delivery or parturient uterine-incision delivery,family members requirements caused uterine-incision delivery were increasing(P<0.001).To compare among 3 groups,the incidence rate of macrosomia combined overtime was 11.9%,9.3% and 2.1%(P<0.001),and combined multipara was 8.9%,13.3% and 18.8%(P<0.01).Conclusion:In order to reduce the incidence rate of macmsomia which is an important measure to decrease the rate of uterine-recision delivery and save the life for the mother and the infant,some effective measures should be carried out for pregnant ladies who are foreseen to have a macrosomia.Meanwhile,the health protection and antepartum monitor should be enhanced for multiparas during the perinatal period.