372例双胎妊娠分娩产妇临床统计分析

目的 了解双胎妊娠并发症及妊娠结局。方法 对1996-2005年10年中372例双胎妊娠与同期单胎妊娠24110例进行对比分析。结果 双胎妊娠占1．52％，双胎妊娠产妇的早产、胎儿异常、妊娠高血压综合征高于单胎妊娠；围产儿并发症中新生儿死亡、低体重儿、新生儿窒息高于单胎妊娠的围产儿；第2胎围产儿病死率高；双胎妊娠分娩方式手术率高。结论 加强双胎围产期监护，掌握好两胎儿分娩间隔时间，选择适当的分娩方式，对降低母体并发症及双胎围产儿病死率有重要意义。     

妊娠合并梅毒对妊娠结局的影响

目的：研究妊娠合并梅毒对妊娠结局的影响。方法：对41例妊娠合并梅毒患者及同期分娩者的妊娠结局进行分析。结果：妊娠合并梅毒患者中胎传梅毒19．5％（8／41）；死胎和早产46．3％（19／41），其中死胎12．2％（5／41），早产17．1％（7／41），与同期分娩者死胎和早产11．9％（659／5532），死胎3．5％（194／5532），早产8．4％（465／5532）比较，差异有显著性（P＜0．05），妊娠合并梅毒治疗组不良妊娠结局为37．1％（13／35），未治疗组为100．0％（6／6），差异有显著性（P＜0．05）。结论：妊娠合并梅毒会增加不良妊娠结局的发生，妊娠期规范治疗可减少不良妊娠结局的发生。     

164例围产儿死亡回顾分析

目的 分析围产儿死亡原因，以提高围产期保健及产科工作质量，降低围产儿死亡率。方法按照围产Ⅰ期标准，对我院8年间164例围产儿死亡情况进行统计分析。结果8年间围产儿死亡率为9．59‰。164例中：新生儿死亡占47．56％，死胎占42．68％．死产占9．76％。总新生儿死亡率为4．56‰，呈逐年下降趋势。导致围产儿死亡原因为早产、胎儿畸形、缺氧综合征，新生儿死因以畸形、缺氧综合征及呼吸道疾病为主。结论加强孕期保健，预防早产，防止并发症发生是降低围产儿死亡的主要措施。     

36例妊娠期梅毒与其梅毒儿情况的临床分析

梅毒是高度传染的性传播疾病。妊娠期梅毒螺旋体由母体通过胎盘进入胎儿血循环中所致的梅毒称先天性梅毒，又称胎传梅毒，可引起胎儿宫内感染，造成流产、死胎、早产、死产、畸形或分娩先天梅毒儿。近几年来梅毒发病率呈不断上升的趋势，且年轻妇女梅毒患者不断增加，多数为早期梅毒，具有宫内胎传的危险性，影响优生优育，对围生儿危害极大，是高危的重点监护内容之一。     

55例妊娠期肝内胆汁淤积症结局分析

妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP），是妊娠期特有的一种并发症，多发生于妊娠中、晚期，主要表现为皮肤搔痒或黄疸以及肝功能异常，其病因不明，该病最大的危害在于其围产儿预后不良，可导致早产、胎儿窘迫、死胎、死产。ICP患者胎死宫内的发生通常十分迅速，且发生胎儿窘迫、死胎的原因目前尚未阐明，亦缺乏有效的防治措施。     

342例妊娠期肝内胆汁淤积症临床分析

目的 分析妊娠期肝内胆汁淤积症（ICP）的胆汁酸（TBA）升高程度与妊娠结局的关系,为临床诊治提供依据.方法 将本院住院分娩的342例ICP产妇按胆汁酸的升高程度分为轻度ICP组、重度ICP组,比较两组间胎儿窘迫、羊水粪染、死胎、早产、低体重儿、剖产率、产后出血率之间的关系.结果 342例ICP患者中轻度占68.1%,重度占31.9%,.重度ICP组中胎儿窘迫、羊水粪染、早产及死胎发生率明显高于轻度ICP组,其差异均有统计学意义（P＜0.01）,而2组产妇出生低体重儿发生率差异无统计学意义（P＞0.05）.342例ICP患者剖宫产占67.25%,产后出血占6.4%.重度ICP组剖宫产率产后出血率明显高于轻度ICP组,其差异均有统计学意义（P＜0.05或P＜0.01）.结论 重度ICP组产妇母胎结局也不良,临床上应加强母胎儿监护和生化指标的监测、早期干预,适时终止妊娠可以改善母胎结局.     

职业性铅暴露对女性生殖功能影响的Meta分析

目的：综合分析职业性铅暴露与女性生殖功能之间的关系,为制订防制措施提供科学依据。方法：通过计算机和手工检索,收集国内发表的关于职业性铅暴露与女工生殖功能关系的文献,按纳入和剔除标准严格筛选,采用Meta分析合并文献效应值,并进行一致性检验及发表偏倚检验。结果：共纳入17篇文献,职业性铅暴露与女性痛经关系的合并OR值（95% CI）为3．38（1．45,7．87）、周期异常的合并OR值（95％CI）为2．37（1．95,2．88）,先兆流产的合并OR值（95% CI）为4．24（2．19,8．22）,妊娠高血压的合并OR值（95％CI）为3．37（1．09—10．44）,死产死胎的合并OR值（95％CI）为3．90（2．43,6．56）,自然流产的合并OR值（95％CI）为3．10（2．17,4．43）,新生儿低体重的合并OR值（95％CI）为4．47（2．78,7．21）,畸形的合并OR值（95％CI）为3．63（2．12,6．22）。结论：女工职业性铅暴露可影响其生殖功能,应对其进一步采取保护措施。     

北京市门头沟区2002—2011年围产儿死亡回顾性分析

目的分析及研究探讨围产儿死亡原因，以提高围产保健的工作质量，降低围产儿死亡率。方法对北京市门头沟区2002—2011年围产儿死亡资料进行回顾性分析。结果10年间围产儿死亡率7．04％。死胎占66．26％，死产占6．75％，新生儿死亡占26．99％。导致围产儿死亡的主要并发症及死因为早产、胎儿畸形、妊娠并发症，死胎中以畸形、脐带因素为主，新生儿死亡以RDS及缺氧综合征为主。结论加强孕期监护，预防早产，防止并发症发生，是降低围产儿死亡率的主要措施。     

妊娠期肝内胆汁淤积症患者的临床护理体会

妊娠期肝内胆汁淤积症（ICP）,是妊娠期特有的一种并发症,多发生于妊娠中、晚期,主要表现为皮肤瘙痒和黄疸,主要危害胎儿,可导致早产、羊水胎粪污染及胎儿宫内窘迫甚至死胎。有报道ICP早产的发生率可高达30％~60％,羊水混浊发生率为25．0％~43．9％,产后出血率高达19．0％~22．2％。     

中国南北方部分地区1994-2000年孕产妇系统保健状况及其变化

目的 了解中国南北方部分地区1994—2000年的孕产妇系统保健状况及其变化。方法 数据来自“中美预防出生缺陷和残疾合作项目”中13个县（市）的围产保健监测数据库。研究对象为19942000年在上述项目县（市）分娩了孕满20周单胎活产儿的368589名妇女。结果 从19942000年，南北方地区产前检查率一直高于99．0％，第一次产前检查时的平均孕周从1994年13．1周提前至2000年的10．7N，早孕检查率从65．5％升至79．4％，产前检查次数≥5次的比例从34．1％升至71．8％，住院分娩率从913％升至98．8％，家庭分娩率从5．6％降至0．6％，产后访视次数≥3次的比例从80．5％升至951％。除早孕检查率外，同期比较，北方地区的其他各率均低于南方地区，且北方地区的城乡差别大于南方地区。结论 中国南北方地区的孕产妇系统保健状况得到了极大的改善，但南北地区之间、北方城乡之间存在明显的差别。     

Mortgage discrimination and preterm birth among African American women: An exploratory study

ObjectiveTo examine whether mortgage discrimination, or redlining, is a risk factor for preterm birth among African American women in Chicago, and how it is related to racial residential segregation.MethodsThis was a retrospective cross-sectional study in Chicago, Illinois, 1989–1991.African American mothers (n = 33,586) in the Illinois Transgenerational Birth File were linked to the 1990 census and the 1990–1995 Home Mortgage Disclosure Act database. Logistic regression models assessed the relationship between redlining and preterm birth rates.ResultsPreterm birth rates were higher among African American women in redlined areas (18.5%) vs. non-redlined areas (17.1%). Unadjusted and adjusted odds ratio for preterm birth among African American women in redlined neighborhoods, compared to non-redlined neighborhoods, were 1.08 (95% CI 1.03-1.14) and 1.12 (1.04-1.20), respectively. By level of racial residential segregation, preterm birth rate was elevated (18.2%) in redlined, high-proportion African American areas compared to non-redlined high-proportion African American areas (16.7%), redlined low- (16.2%) and mid-proportion (16.1%) African American areas.ConclusionsMortgage discrimination may be an important measure of institutional racism to be used in understanding racial disparities in preterm birth.     

Rising preterm birth rates, 1989–2004: Changing demographics or changing obstetric practice?

Preterm birth rates are higher in the United States than in most industrialized countries, and have been rising steadily. Some attribute these trends to changing demographics, with more older mothers, more infertility, and more multiple births. Others suggest that changes in obstetrics are behind the trends. We sought to determine what the preterm birth rate in 2004 would have been if demographic factors had not changed since 1989. We examined complete US birth certificate files from 1989 and 2004 and used logistic regression models to estimate what the 2004 preterm birth rates (overall, spontaneous, and medically induced) would have been if maternal age, race, nativity, gravidity, marital status, and education among childbearing women had not changed since 1989. While the overall preterm births increased from 11.2% to 12.8% from 1989 to 2004, medically induced rates increased 94%, from 3.4% to 6.6%, and spontaneous rates declined by 21%, from 7.8% to 6.2%. Had demographic factors in 2004 been what they were in 1989, the 2004 rates would have been almost identical. Changes in multiple births accounted for only 16% of the increase in medically induced rates. Our analysis suggests that the increase in preterm births is more likely due primarily to changes in obstetric practice, rather than to changes in the demographics of childbearing. Further research should examine the degree to which these changes in obstetric practice affect infant morbidity and mortality.     

妊娠晚期血红蛋白浓度与早产和低出生体重关系的研究

目的分析妊娠晚期血红蛋白(Hb)浓度与早产和低出生体重之间的关系。方法研究对象为江苏和浙江省4个县(市)在1995—2000年间分娩的102 489名妇女。按妊娠晚期Hb浓度分四组比较各组早产和低出生体重的发生率;采用logistic回归模型控制年龄、职业、文化程度、孕次、产检次数和妊高征等因素后,估计Hb与早产和低出生体重的关联程度。结果妊娠晚期贫血患病率为48.2%,以轻度和中度贫血为主。轻、中度贫血不增加早产和低出生体重的风险。当Hb为90～99 g/L时,早产和低出生体重的发生率最低;当Hb升高或降低时,早产和低出生体重的风险均呈增加趋势。Hb为70～119 g/L时,早产和低出生体重的风险变化不大,但重度贫血和高血红蛋白则显著增加早产和低出生体重的风险:Hb<70 g/L组早产和低出生体重的OR(95%CI)分别为1.8(1.0～3.3)和4.0(2.1～7.5);Hb≥130 g/L组的早产和低出生体重的OR(95%CI)为1.2(1.0～1.4)和1.5 (1.2～1.9)。结论妊娠晚期Hb水平与早产和低出生体重的风险之间均呈"U"形趋势,妊娠晚期重度贫血以及高血红蛋白均是早产和低出生体重的危险因素。     

The Association Between Major Birth Defects and Preterm Birth

Objective To evaluate the association between preterm birth and major birth defects by maternal and infant characteristics and specific types of birth defects. Study Design We pooled data for 1995–2000 from 13 states with population-based birth defects surveillance systems, representing about 30% of all U.S. births. Analyses were limited to singleton, live births from 24–44 weeks gestational age. Results Overall, birth defects were more than twice as common among preterm births (24–36 weeks) compared with term births (37–41 weeks gestation) (prevalence ratio [PR] = 2.65, 95% confidence interval [CI] 2.62–2.68), and approximately 8% of preterm births had a birth defect. Birth defects were over five times more likely among very preterm births (24–31 weeks gestation) compared with term births (PR = 5.25, 95% CI 5.15–5.35), with about 16% of very preterm births having a birth defect. Defects most strongly associated with very preterm birth included central nervous system defects (PR = 16.23, 95% CI 15.49–17.00) and cardiovascular defects (PR = 9.29, 95% CI 9.03–9.56). Conclusions Birth defects contribute to the occurrence of preterm birth. Research to identify shared causal pathways and risk factors could suggest appropriate interventions to reduce both preterm birth and birth defects.     

中国3省市21家医院早产发生的相关因素及结局研究

目的 分析早产发生的影响因素与结局,为早产的防治工作提供依据. 方法 对3省市21家医院完成分娩的全部产妇13 322例进行调查,计算早产发生率,分析早产发生的相关因素,比较早产儿与足月儿的新生儿结局. 结果 早产发生率为6.0％,其中晚期早产（孕周34～36周）占77.3％;导致早产发生危险增加的因素有年龄＜20岁、年龄＞35岁、在校读书年数＞12年、多胎、发生妊娠合并症;早产导致死胎或死产,低、极低出生体重,Apgar得分≤7分,进入新生儿重症监护室,出院前或生后7d内死亡的危险增加. 结论 早产是威胁胎儿及新生儿健康的重要因素,应尽早识别具备早产危险因素的孕妇,以便及时开展针对性的治疗工作.     

Smoking during pregnancy according to obstetric complications and parity: results of the EUROPOP study

This study aimed to analyse the relationship between smoking and preterm birth (22-36 weeks) according to the main obstetric complications leading to the preterm birth, both overall and by parity. The EUROPOP study is a case-control study carried out between 1994 and 1997; 3,787 preterm and 5,602 full-term births were included, from maternity units in 10 countries, using the same protocol. Social, demographic and medical information was collected after delivery, from obstetric records and interviews with the mothers. Cases were classified according to the main obstetric complication (hypertension, haemorrhage, preterm premature rupture of membranes (PPROM), idiopathic spontaneous preterm labour, intrauterine growth retardation, all other causes). Multiple logistic regression analysis was used to control for confounders. Twenty four percent of cases and 20% of controls were smokers. Smoking during pregnancy, heavy smoking (>or=10 cigarettes per day) in particular, was a risk factor for preterm birth (aOR = 1.39, 95% CI:1.20-1.60). Smoking increased the risk of preterm delivery due to all obstetric complications other than hypertension. For these complications, the risk of preterm delivery associated with smoking was higher for multiparae (aOR = 1.46, 95% CI:1.24-1.71) than for primiparae (aOR = 1.18, 95% CI:1.00-1.38). In conclusion, smoking during pregnancy increases the risk of preterm birth among women with all obstetric complications except hypertension. This association is stronger in multiparae than in primiparae and the risk is higher for heavy smokers.     

Maternal acute respiratory infectious diseases during pregnancy and birth outcomes

The objective of the study was to evaluate the possible association between maternal acute respiratory infectious diseases (ARID) during pregnancy and birth outcomes. Newborn infants born to mothers with or without ARID as reference were compared in the population-based large data set of newborns without any defect in the Hungarian Case–Control Surveillance System of Congenital Abnormalities. Main outcome measures were birth weight and gestational age at delivery, in addition the rate of preterm births and low birthweight newborns. Of 38,151 newborns, 3,455 (9.1%) had mothers with ARID during pregnancy which were differentiated according to six manifestations from sinusitis to the pneumonia. Mothers with ARID in pregnancy had a longer (0.3 week) gestational age at delivery (adjusted t = 5.4; p < 0.0001) and a lower rate of preterm births (6.7% vs. 9.4%) [adjusted odds ratio (OR) with 95% confidence interval (CI): 0.72, 0.63–0.83] than mothers without ARID. However, severe ARID (bronchitis–bronchiolitis and particularly pneumonia) associated with a higher rate of preterm births (13.0%, adjusted OR with 95% CI: 1.4, 1.1–1.8), while mild ARID (sinusitis, pharyngitis, tonsillitis, laryngitis–tracheitis) resulted in a lower rate of preterm births (5.5%, adjusted OR with 95% CI: 0.5, 0.4–0.7). In conclusion, there was an obvious correlation between severity of ARID in pregnant women and rate of preterm births.     

Impact of maternal characteristics on the effect of maternal influenza vaccination on fetal outcomes

Background

Maternal infections during pregnancy have been associated with adverse fetal and infant health outcomes, and vaccination against influenza is the most effective tool to prevent morbidity and mortality due to seasonal and pandemic influenza. We evaluated the association between receipt of the inactivated seasonal influenza vaccine on preterm and small for gestational age (SGA) births, with the aim to assess racial and socioeconomic variations in vaccine effect.

Methods

We conducted a retrospective analysis of state-wide surveillance data from Georgia for the most recent four years available at the beginning of the study, a total of 8393 live births in Georgia from January 1, 2005 through December 31, 2008. We constructed multivariable logistic regression models and calculated odds ratios (OR) estimates with corresponding 95% confidence intervals (CI) to evaluate the effect of maternal influenza vaccination on SGA (birth weight <10th percentile for gestational age) and preterm (gestational age at birth <37 weeks) births while controlling for potential confounders.

Results

Among all women, we found significant strong associations between maternal influenza vaccination and reduced odds of a preterm birth during the widespread influenza activity period [OR = 0.39, 95% CI: 0.18, 0.83]. In this period, vaccination was protective against SGA births among women at higher risk for influenza related morbidity – women enrolled in the Women, Infant and Child (WIC) program [OR = 0.20, 95% CI: 0.04, 0.98] and Black women [OR = 0.15 95% CI: 0.02, 0.94]; maternal influenza vaccination was associated with reduced odds of a preterm birth among white women [OR = 0.34, 95% CI: 0.12, 0.91] and women of higher socio-economic status [OR = 0.30, 95% CI: 0.12, 0.74].

Conclusion

Influenza vaccination during pregnancy was significantly associated with reduced odds of small for gestational age and preterm births during the widespread influenza activity period. Vaccination effects varied by socio-demographic characteristics.     

强制婚检取消前后不良妊娠结局及其危险因素暴露比较

目的:评价婚检政策变化对妇女孕早期危险因素暴露及母婴健康的可能影响。方法:回顾调查浙江、江苏22个县市2001年1月~2005年12月间分娩的孕产妇,共484783例。采用单变量统计分析方法,比较2003年前后某些危险因素的暴露频率、新生儿早产、新生儿低体重及肉眼可见畸形的发生率。结果:新生儿早产发生率出现波动,趋势尚不明显;新生儿低体重及肉眼可见畸形的发生率2003年后较2003年前有不同程度的上升。2003年后孕前6月内服用避孕药物、孕早期服用可疑致畸药物、接触放射线及饮酒的比例较2003年前明显增加;孕早期风疹病毒、巨细胞病毒、单纯疱疹病毒等病原体感染的检出率2003年后也有所上升。低龄及高龄孕产妇的比例也不断上升。结论:强制婚检的取消增加了妇女危险因素暴露的机会,对妊娠结局有不利影响。     

Birth Outcomes Among Older Mothers in Rural Versus Urban Areas: A Residence‐Based Approach

Purpose: We examined the association between rural residence and birth outcomes in older mothers, the effect of parity on this association, and the trend in adverse birth outcomes in relation to the distance to the nearest hospital with cesarean‐section capacity. Methods: A population‐based retrospective cohort study, including all singleton births to 35+ year‐old women in British Columbia (Canada), 1999‐2003. We compared birth outcomes in rural versus urban areas, and between 3 distance categories to a hospital (<50, 50‐150, >150 km). Outcomes included labor induction, cesarean section, stillbirth, perinatal death, preterm birth (<37 weeks), small‐for‐gestational‐age, large‐for‐gestational‐age, and neonatal intensive care unit admission. We used multivariate regression to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Findings: Among the 29,698 subjects, 11.5% lived in rural areas; 5% lived within 50‐150 km; and 1.1% lived >150 km from a hospital. Rural women were at lower risk of primary and repeat cesarean section (OR = 0.9, CI: 0.9‐1.0; OR = 0.7, CI: 0.6‐0.9) and small‐for‐gestational‐age (OR = 0.8, CI: 0.7‐0.9) births; they were at increased risk for perinatal death (OR = 1.5, CI: 1.1‐2.1) and large‐for‐gestational‐age (OR = 1.1, CI: 1.1‐1.2) births. The association was stronger among multiparous versus primiparous women. No differences in emergency cesarean section, preterm birth, or neonatal intensive care admission were found, regardless of parity. Perinatal mortality increased with distance from hospital; OR = 1.5 (CI: 1.1‐2.1) per distance category. Conclusions: Older women in rural versus urban areas had a lower rate of cesarean section and increased risk of perinatal death. The risk of perinatal death increased with the distance to hospital. Further studies need to evaluate the contribution of underlying perinatal risks, access to care, and decision making regarding referral and transport.