高龄妊娠对产后出血的影响

目的探讨孕妇高龄是否对产后出血产生影响。 方法采用回顾性研究方法对2009年1月1日至2014年12月31日在广州医科大学附属第三医院妇产科住院分娩的年龄≥18岁单胎产妇28 839例的临床资料进行分析,按照孕妇分娩年龄进行分组,≥35岁为高龄组(3 670例),18～34岁为适龄组(25 169例),比较两组产后出血发病率、首发病因和妊娠结局;采用独立样本t检验、秩和检验、χ²检验对数据进行统计学分析。 结果本研究总的产后出血发生率为3.75%(1 081/28 839);高龄组产后出血发病率4.66%(171/3670),比适龄组产后出血发病率3.62%(910/25 169)高(χ²＝9.673,P＝0.002)。高龄组产后出血首发病因分别为：子宫收缩乏力(55.55%)、胎盘因素(39.77%)、软产道裂伤(3.51%)、凝血功能障碍(1.17%)。高龄组平均住院天数、顺产产后出血量、子宫切除率、转重症监护病房比例、输红细胞比例均高于适龄组,分别为(9.36±0.59)d和(6.42±0.96)d,(799.09±30.55)ml和(742.44±11.34)ml,12.87%和4.51%,5.8%和2.75%,28.65%和17.25%,P均<0.05。 结论高龄妊娠的孕妇更容易发生产后出血,且结局较差,子宫收缩乏力及胎盘因素是主要原因。     

妊娠方式对双胎妊娠母胎围产结局影响的研究

目的：探讨不同妊娠方式对双胎妊娠母胎围产结局的影响。方法：回顾性分析2019年1月—2023年1月在湖南师范大学附属长沙市妇幼保健院分娩的815例双胎孕产妇的临床资料,依据妊娠方式分为自然妊娠组（398例）和体外受精-胚胎移植（in vitro fertilization-embryo transfer,IVF-ET）组（417例）,比较2组孕产妇基本资料、妊娠并发症及母胎围产结局。结果：IVF-ET组孕产妇年龄、分娩孕周、初产妇比例、多囊卵巢综合征比例、双绒毛膜双羊膜囊比例、妊娠期糖尿病发生率、剖宫产率、产后出血量和产后出血率均高于自然妊娠组,瘢痕子宫比例低于自然妊娠组（均P<0.05）。IVF-ET组新生儿早产率和转新生儿科率低于自然妊娠组,较大新生儿出生体质量高于自然妊娠组（均P<0.05）。结论：通过IVF-ET妊娠的双胎孕产妇围产期并发症发生率升高,需要严格把握胚胎移植的指征,严控移植的胚胎数目,加强围产期的管理,降低妊娠并发症的发生率,最大程度保障母婴安全。     

高龄孕妇子痫前期并发胎盘早剥妊娠结局分析

目的 探讨高龄对子痫前期并发胎盘早剥母儿结局的影响.方法 回顾性分析2017年1月至2019年12月在广州医科大学附属第三医院住院分娩的子痫前期并发胎盘早剥、单胎妊娠患者40例,以年龄≥35岁者为高龄组(14例),年龄<35岁者为对照组(26例),比较两组患者的临床资料特点、生化指标及围产儿结局.结果(1)两组孕妇一般...     

子痫前期孕妇的血清尿酸水平对母胎妊娠结局的预测作用

【摘 要】 目的：探讨子痫前期孕妇分娩前1个月内的血清尿酸水平对预测母胎妊娠结局的价值。方法：选取2014年4月-2015年12月在上海市第六人民医院分娩的152例子痫前期孕妇进行回顾性分析。所有入选者根据子痫前期严重程度、发病孕周分别分为重度组（106例）、非重度组（46例）及早发型组（75例）、晚发型组（77例）。收集孕妇分娩前1个月内的血清尿酸,选取病情最严重时对应的数值;妊娠并发症如胸腹腔积液、肝肾功能不全;围生儿健康指标如新生儿出生体质量、Apgar评分。结果：早发型或重度子痫前期孕妇的血清尿酸水平分别比晚发型或轻度子痫前期孕妇的明显升高（P＜0.01）。通过二分类Logistics回归分析发现：血清尿酸水平升高是子痫前期不良母胎结局的危险因素之一。受试者工作特征（receiver operating characteristic,ROC）曲线进一步表明：血清尿酸水平升高达到388～440 μmol/L,对预测子痫前期不良母胎结局的发生差异有统计学意义（P＜0.01）。结论：血清尿酸水平对评估子痫前期孕妇的不良母胎结局、选择评估终止妊娠时机具有重要的预测价值,需要临床医师予以高度重视。     

高龄糖尿病孕妇的妊娠结局及应对策略

妊娠期间的糖尿病包括糖尿病合并妊娠和妊娠期糖尿病两种,均可引起母儿不良结局,需要规范的管理和干预。随着"二孩政策"的全面实施,高龄孕妇(≥35岁)逐渐增多。本文就高龄糖尿病孕妇的妊娠结局及处理对策进行讨论。     

高龄初产妇妊娠结局分析

目的:探讨不同年龄段高龄初产孕妇妊娠分娩结局。方法:回顾分析西北妇女儿童医院2016年1月1日至2020年1月1日分娩的2272例高龄初产妇的临床资料,其中高龄组(35～39岁)2040例,超高龄组(≥40岁)232例。比较孕产妇年龄与妊娠结局及围产儿结局的关系。结果:高龄组及超高龄组的剖宫产率分别为62.84%及88.79%,新生儿转ICU率分别为4.46%及7.76%,产后出血率分别为1.76%及3.02%。高龄组和超高龄组的剖宫产率、新生儿转ICU、胎膜早破比较,差异均有统计学意义(P均<0.05)。两组的低出生体重儿、巨大儿、早产、死产、低Apgar评分、新生儿发育异常、产后出血方面比较,差异均无统计学意义。高龄组、超高龄组剖宫产指征中“孕妇要求的剖宫产”占比均最高,分别为39.70%和79.38%。结论:高龄初产孕妇中,剖宫产率随着年龄增加,“孕产妇要求的剖宫产”占比增加明显,在围产儿及孕产妇并发症方面,除新生儿转ICU有所增加,严重并发症并不增加。     

妊娠合并肝功能损害对妊娠结局的影响

目的探讨妊娠合并肝功能损害(妊娠肝损)对妊娠结局的影响.方法分析比较了80例妊娠肝损患者及同期随机抽查的56例非肝损患者(对照组)的临床资料.结果肝损组新生儿体重、分娩孕周均显著低于对照组(P＜0.05);肝损组羊水污染率明显高于对照组(P＜0.05),肝损组新生儿窒息率高于对照组,但无统计学差异;肝损组血ALT＞500nmoL@S-1/L患者与ALT＜500nmoL@S-1/L的患者相比,早产儿发生率明显增加(P＜0.05).结论妊娠肝损可影响新生儿的体重,且羊水污染机会明显增加,积极正确的处理可以使肝损患者安全度过围产期并能提高围生儿的生存质量.     

妊娠间隔对妊娠结局影响的研究进展

妊娠间隔过短或者过长均会导致妊娠不良结局的增加,也会导致妊娠期糖尿病、子痫前期和胎儿近期或远期并发症的增加。目前对于最佳妊娠间隔范围还没有统一的结论,多数研究给出的最佳范围在18～60个月。而妊娠间隔对妊娠结局的作用受多种因素的干扰,如孕次、孕周、年龄、前次妊娠史、受孕方式、社会经济因素等。目前妊娠间隔对妊娠结局影响作用机制的假说,较多的认为是过短妊娠间隔是由于母体体内物质缺乏所致,而过长妊娠间隔则是机体的衰老等因素共同影响所致,但相关临床及基础研究均较少,仍需要更多的研究进行阐释。     

妊娠期发热对妊娠结局的影响

发热是妊娠期的常见症状,妊娠期发热可以对孕妇和胎儿产生不利影响,需要进行全面系统的评估和判断。本文将阐述妊娠期发热的原因及对子代和孕妇的影响,从而为临床诊治提供参考依据。     

SARS感染对妊娠结局及胎、婴儿的影响

目的 观察中晚期妊娠合并严重急性呼吸综合征(severe acute respiratory syndrome，SARS)对妊娠结局及胎要儿的影响。方法 分析6例妊娠合并SARS的临床特征、妊娠结局，检测母儿SARS病毒抗体、RNA，随访要儿情况。结果6例(双胎妊娠2例)SARS患者娩出新生儿7例，其中早产2例，胎儿窘迫3例；1例双胎妊娠之一胎儿死亡，另一胎儿生长受限；新生儿均无窒息、SARS迹象。产妇冠状病毒抗体IgG均阳性，要儿4例阳性、3例阴性；母儿IgM抗体、病毒RNA均阴性。早产儿(3例)体格智能发育稍落后，足月儿(4例)正常。结论 中晚期妊娠合并SARS对围产结局有一定的不良影响，但未发现SARS病毒的垂直传播。     

Effect of parity and advanced maternal age on obstetric outcome.

OBJECTIVES: To examine the effect of parity on obstetric outcome in women aged 40 years or older. METHODS: A retrospective cohort of 16 427 singleton pregnancies delivered between 1998 and 2001 was studied. Obstetric outcomes in women aged 40 years or older versus women younger than 40 years were compared for both nulliparous and multiparous women. RESULTS: Of the 15 727 pregnancies (95.7%) that satisfied the inclusion criteria, 606 (3.9%) were in women aged 40 years or older. Advanced age was independently associated with cesarean delivery, birth and spontaneous preterm labor before 37 weeks, and low birth weight neonates in nulliparous women, but only with preterm birth before 37 weeks and cesarean delivery in multiparous women. CONCLUSION: Obstetric outcome in women aged 40 years or older was influenced by parity. Cesarean delivery and preterm birth before 37 weeks were independently associated with older age irrespective of parity. Advanced age is a risk factor for preterm birth.     

Pregnancy outcome in primiparae of advanced maternal age

OBJECTIVE: To investigate the impact of maternal age on singleton pregnancy outcome, taking into account intermediate and confounding factors. STUDY DESIGN: In this population-based retrospective cohort study, perinatal data of primiparous women aged 35 years or more (n = 2970), giving birth to a singleton child of at least 500 g, were compared to data of primiparous women aged 25-29 years old (n = 23,921). Univariate analysis was used to assess the effect of maternal age on pregnancy outcomes. The effects of intermediate (hypertension, diabetes and assisted conception) and confounding factors (level of education) were assessed through multivariable logistic regression analysis. RESULTS: Older maternal age correlated, independently of confounding and intermediate factors, with very preterm birth (gestational age <32 weeks) [adjusted odds ratio (AOR) 1.51, 95% confidence intervals (CI) 1.04-2.19], low birth weight (birth weight <2500 g) (AOR 1.69, 95% CI 1.47-1.94) and perinatal death (AOR 1.68, 95% CI 1.06-2.65). CONCLUSION: Maternal age is an important and independent risk factor for adverse pregnancy outcome.     

高龄妇女接受体外受精-胚胎移植的结局

目的　探讨高龄妇女接受体外受精 胚胎移植 (IVF ET)治疗后妊娠及围产情况。方法　对 1999年 1月至 1999年 12月 ,139例接受常规IVF ET治疗和 6 9例卵母细胞浆内单精子注射(ICSI)治疗的 2 0 8例高龄 (36～ 4 5岁 )妇女的临床资料进行回顾性分析。结果　 2 0 8例共妊娠 4 8例 ,妊娠率为 2 3 1%。 36、37、38、39及 4 0～ 4 5岁组妇女的不孕原因、不孕年限、治疗次数、卵裂率、移植胚胎情况等比较 ,差异均无显著性 (P >0 0 5 )。随年龄增加 ,卵泡数明显减少 ,各年龄组分别为 (14 7±1 2 )、(13 0± 2 0 )、(11 3± 0 9)、(9 7± 0 9)及 (6 5± 1 9)个 ;妊娠率明显下降 ,分别为 2 4 1、2 0 5、13 2、11 1及 9 8% ;种植率也明显下降 ,分别为 15 6、11 2、10 5、6 5和 2 2 % ;而流产率则明显增高 ,分别为 2 3 0、2 7 2、33 4、4 1 2及 4 3 3% ;多胎妊娠率分别为 31 2、2 7 3、15 4、6 7及 0 0 %。各年龄组上述指标比较 ,差异均有显著性 (P <0 0 5 )。除新生儿体重外 ,各年龄组在产科结局方面差异无显著性。结论　 37岁以上妇女接受IVF ET的妊娠率及种植率明显下降 ,≥ 4 0岁妇女下降明显加快 ;移植3个以上胚胎可能有利于提高妊娠率 ,同时不增加多胎妊娠。     

Advanced maternal age and adverse perinatal outcomes in an Asian population

Objective

To investigate (1) whether there is an increasing trend in the mean maternal age at the birth of the first child and in the group of women giving birth at age 35 or older, and (2) the association between advanced maternal age and adverse perinatal outcomes in an Asian population.

Study design

We conducted a retrospective cohort study involving 39,763 Taiwanese women who delivered after 24 weeks of gestation between July 1990 and December 2003. Multivariable logistic regression was used to adjust for potential confounding variables.

Results

During the study period, the mean maternal age at the birth of the first child increased from 28.0 to 29.7 years, and the proportion of women giving birth at age 35 or older increased from 11.4% to 19.1%. Compared to women aged 20–34 years, women giving birth at age 35 or older carried a nearly 1.5-fold increased risk for pregnancy complications and a 1.6–2.6-fold increased risk for adverse perinatal outcomes. After adjusting for the confounding effects of maternal characteristics and coexisting pregnancy complications, women aged 35–39 years were at increased risk for operative vaginal delivery (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2–1.7) and cesarean delivery (adjusted OR 1.6, 95% CI 1.5–1.7), while women aged 40 years and older were at increased risk for preterm delivery (before 37 weeks of gestation) (adjusted OR 1.7, 95% CI 1.3–2.2), operative vaginal delivery (adjusted OR 3.1, 95% CI 2.0–4.6), and cesarean delivery (adjusted OR 2.6, 95% CI 2.2–3.1). In those women who had a completely uncomplicated pregnancy and a normal vaginal delivery, advanced maternal age was still significantly associated with early preterm delivery (before 34 weeks of gestation), a birth weight <1500 g, low Apgar scores, fetal demise, and neonatal death.

Conclusion

In this population of Taiwanese women, there is an increasing trend in the mean maternal age at the birth of the first child. Furthermore, advanced maternal age is independently associated with specific adverse perinatal outcomes.     

Impact of advanced maternal age on pregnancy outcome

The aim of this study was to compare the pregnancy outcome and delivery complications in women 40 years or older (cases) to that of women 20 to 30 years old (controls). Over a 5-year period, 319 cases had a singleton delivery in our institution. These women were compared with 326 controls. Parity was significantly higher in cases compared with controls (3.2 vs. 1.8). Advanced maternal age, compared with younger age, was associated with significantly higher rates of preterm delivery (16.0 vs. 8.0%), cesarean delivery (CS) (31.3 vs. 13.5%), and the occurrence of one or more antepartum complications (29.5 vs. 16.6%). When the two groups were subdivided according to parity, rates of preterm delivery, CS, preeclampsia, gestational diabetes, chronic hypertension, and labor induction were each significantly higher among older multiparas compared with control multiparas. However, only preterm delivery, CS rates, and uterine fibroids were found to be significantly higher in older nulliparous compared with young nulliparous women. We conclude that multiparous women at least 40 years old have a higher antepartum complication rate including intrauterine fetal death compared with younger women.     

The association between young maternal age and pregnancy outcome

Abstract

Objective: We aimed to determine the association between young maternal age at delivery with adverse pregnancy outcome in a single, tertiary, university-affiliated medical center.

Methods: A retrospective, cohort, matched control study using the first percentile distribution of maternal age at delivery (21 years old, n?=?461) as the study group, and four control groups by maternal age matched by parity in a 2:1 ratio (22–25, 26–30, 31–35 and 36–40 years; n?=?922 each).

Results: Women aged ≤21 years were found to have lower rates of chronic hypertension [compared with women aged 36–40 years old (0.0% versus 1.3%, p?<?0.05)], lower rates of gestational diabetes mellitus (GDM) (1.3% versus 3.7%, p?=?0.007), higher rates of perineal lacerations [compared with women aged 31–35 and 36–40 years old, 41% versus 31.8% and 31.1%, respectively, p?<?0.01)], higher rates of postpartum hemorrhage (4.6% versus 1.5%, p?<?0.0001) and higher rates of low 5-min Apgar score (2.2% versus 0.8%, p?=?0.004). No significant differences were found in terms gestational age at delivery, birth weight, fetal sex, intrapartum or antepartum mortality.

Conclusion: Young maternal age at delivery is associated with increased risk of short-term complications after delivery.     

Impact of advanced maternal age on the outcome of pregnancy

We assessed the impact of advanced maternal age on the outcome of pregnancy by studying all 1,328 women who were primarily cared for and delivered at our institution between 14 September 1984 and 12 February 1985. Important peripartum maternal complications were no more frequent in women aged 35 years or more than in women 20 to 34 years old, although operative delivery was significantly more common. Similarly, adverse outcomes of infants were no more frequent. Perinatal mortality tended to be lower. In addition, we noted a trend for fewer infants with congenital anomalies to be born among older women. This trend was related, in part, to the choice to terminate the pregnancy by women with fetuses that had documented chromosomal anomalies. We conclude that advanced maternal age was not associated with an excess of adverse pregnancy outcome and suggest that, with early registration and careful surveillance during pregnancy, women aged 35 years or more can experience excellent pregnancy outcomes.     

The risks and outcome of pregnancy in an advanced maternal age in oocyte donation cycles

Abstract

The maternal age at the first and repeated deliveries constantly rises in developed countries due to current social trends that favor values of personal achievements upon procreation. Assisted reproduction technologies and especially the availability of oocyte donation programs extend the age of fecundity to the fifth and sixth decades of life. The ability to conceive and deliver at such age raises serious medical, moral, social and legal concerns regarding the health and welfare of the mother and child will be presented and discussed here.