高龄初产对妊娠结局的影响

目的　探讨高龄初产对妊娠结局的影响。方法　采用回顾性对照研究 ,对北京大学第一医院 1 981年1月 1日至 2 0 0 2年 1 2月 31日分娩的单胎初产妇临床资料进行分析。比较高龄初产组 (≥ 35岁 )和非高龄初产妇组 (<35岁 )妊娠期糖尿病、巨大胎儿、妊娠期高血压疾病、早产、低出生体重儿的发生率 ,以及剖宫产率的差异。结果　高龄初产组中妊娠期糖尿病 ,巨大胎儿 ,早产和低出生体重儿的发生率明显高于非高龄初产组 ,差异有显著性 (P <0 0 1 )。剖宫产率高龄初产组是非高龄初产组的 2倍。结论　高龄初产妇中妊娠期糖尿病 ,巨大胎儿、早产、低出生体重儿和剖宫产的危险性增加。因此 ,应该避免高龄妊娠。     

95例35岁以上妇女妊娠与分娩分析

回顾性分析１９９３年１月至１９９７年１２月在我院分娩的３５岁以上单胎孕妇９５例,探讨孕妇年龄、产次与妊娠结局的关系。结果表明：高龄初产妇及高龄经产妇妊娠并发症明显高于正常生育年龄初产妇及经产妇（Ｐ＜０．０１）,其妊高征、前置胎盘、子宫肌瘤、早产等并发症的发生率在高龄初产妇与高龄经产妇间无差异（Ｐ＞０．０５）,说明高龄产妇妊娠并发症增加,与产次无关。由于并发症多故剖宫产率增加,产后出血发生率亦升高。高龄初产妇剖宫产率占８７．５０％,明显高于高龄经产妇的３９．６８％（Ｐ＜０．０１）。新生儿出生体重在高龄初产妇及高龄经产妇均低于相应对照组（Ｐ＜０．０５）。巨大儿、低体重、新生儿窒息的发生率及围生儿死亡率在高龄初产妇及高龄经产妇与相应对照组相比无差异（Ｐ＞０．０５）。认为尽管高龄产妇妊娠并发症多,难产率高,但总的新生儿结局不受母亲年龄的影响     

高龄妇女妊娠的产科并发症

随着社会竞争、生活压力的不断增加，人们把大量的精力和时间投入到工作中，平均结婚年龄和生育年龄推迟，加之助孕技术的发展，导致高龄妇女妊娠、分娩人数逐年增加，目前的高龄初产妇是20世纪80年代的3倍。由于35岁以后随年龄增长，妊娠病理随之增加，导致高龄孕产妇并发症及不良妊娠结局发生率明显增高。因此，关注高龄孕产妇妊娠分娩的并发症是现代围生医学的重要内容之一。     

辅助生殖技术受孕和自然受孕双胎妊娠结局的临床比较

目的:探讨辅助生殖技术(ART)受孕双胎妊娠与自然受孕双胎妊娠围生期的结局。方法:回顾分析93例ART受孕双胎妊娠孕妇(研究组)的并发症、分娩方式及围产儿结局,并与同期自然受孕双胎(对照组)451例比较。结果:研究组孕妇平均年龄较高(32.5±3.6岁),分娩孕周较小(33.4±4.3周),住院时间较长(21.1±2.6天),与对照组相比(分别为27.8±3.2岁、35.6±4.1周、11.3±1.5天)差异有显著性(P<0.05)。研究组早产、妊娠期高血压疾病、胎膜早破、前置胎盘、羊水过多的发生率明显高于对照组,两者差异有显著性(P<0.05)。研究组双胎输血综合征明显少于对照组(P<0.01)。两组剖宫产率均在72%以上,差异无统计学意义。研究组新生儿出生体重低、新生儿畸形和新生儿转NICU率高,与对照组相比有统计学差异(P<0.05)。研究组双胎之一胎死宫内率低于对照组(P<0.01)。结论:ART受孕双胎并发症和不良新生儿结局风险大,加强ART受孕双胎妊娠并发症的防治和产前、产时监护,产儿科密切合作和新生儿护理具有重要意义。     

北京大学医学部医院初筛高危因素对妊娠并发异常情况及结局的影响

目的探讨医学社区人群孕期初筛高危对妊娠异常情况及结局的作用。方法选取2012年12月至2018年10月在北京大学医学部医院建立《母子健康手册》孕妇873例,分为初筛高危组和对照组,收集初筛高危因素、孕期及产时产后资料,比较两组妊娠情况及结局,并分析各初筛因素对妊娠结局影响,筛选不良妊娠结局的影响因素。结果高危组年龄及体重指数大于对照组(P0.01);两组孕次、分娩孕周、胎儿结局和分娩方式分布差异有统计学意义(P0.05);高危组妊娠期糖尿病的发生率显著高于对照组(P0.01);高龄和双胎妊娠是不良妊娠结局的独立影响因素(OR=1.91,P0.01OR=5.21,P=0.02)。结论该医学背景人群妊娠初筛高危对妊娠并发异常情况及结局均有显著影响,高龄、双胎妊娠是不良妊娠结局的主要影响因素。     

多囊卵巢综合征对超重或肥胖孕妇围产结局的影响

目的探讨多囊卵巢综合征(PCOS)对超重或肥胖孕妇围产结局的影响。方法对2008年5月至2010年7月在北京妇产医院产科门诊初次就诊孕妇进行PCOS史的筛查,将55例体重指数(BMI)≥24PCOS合并妊娠的单胎孕妇作为研究组,将对照组按年龄及孕前BMI和研究组进行2:1配对,即110例符合条件的非PCOS孕妇被纳入对照组,随访两组的妊娠结局到分娩。多胎妊娠、原有高血压、糖尿病、高血脂、甲状腺功能异常、心脏病、肾脏病等慢性疾病者未纳入本研究。结果 BMI≥24PCOS孕妇早产的发生率(20.0%)明显高于对照组(5.5%),两组差异有统计学意义,P<0.01。而妊娠期糖尿病(GDM)、妊娠期高血压、子痫前期、产后出血等妊娠并发症及新生儿并发症发生率两组比较差异无统计学意义(P>0.05)。结论 PCOS没有增加超重或肥胖孕妇GDM及妊娠期高血压疾病及其他不良围产结局发生的危险,但早产发生的危险显著增高。     

高龄孕妇妊娠期心血管功能异常与妊娠并发症、母婴结局的相关性研究

目的探索高龄孕妇妊娠期心血管功能异常与妊娠并发症、母婴结局的相关性。方法选取2019年1月至2020年12月在河北北方学院附属第二医院规律产检并分娩的高龄妊娠孕妇212例,随机选取同期212例非高龄妊娠孕妇为对照组。记录两组的一般资料、心电图(ECG)异常、妊娠期高血压(HDCP)发生率、妊娠并发症和母婴结局。结果高龄妊娠组经产妇和既往流产史所占比例、ECG异常、HDCP、前置胎盘、产后出血、剖宫产和早产儿发生率均高于对照组(P 0.05);高龄妊娠ECG异常孕妇剖宫产、低体重儿、早产和胎儿窘迫发生率均高于ECG正常组(P 0.05),高龄妊娠HDCP孕妇产后出血、剖宫产、低体重儿、早产和胎儿窘迫发生率均高于非HDCP组(P 0.05)。结论高龄孕妇妊娠期心血管功能异常会增加妊娠并发症和母婴不良结局的发生率。     

高龄对初产妇妊娠结局影响研究

目的探讨高龄对初产妇妊娠结局的影响。方法回顾性分析2010-2013年在广州医科大学附属第三医院妇产科分娩的4821例单胎初产妇。按照年龄分为20~34岁组(对照组,3929例)、34~40岁组(高龄组,775例)和≥40岁组(高龄组,117例)。分析3组初产妇妊娠期疾病的发生情况及妊娠结局。结果纳入研究初产妇中年龄20~34岁占81.50%(3929/4821),34~40岁占16.08%(775/4821),≥40岁占2.43%(117/4821)。与对照组相比,剖宫产、妊娠期高血压、重度子痫前期、妊娠期糖尿病、产后出血以及前置胎盘、胎儿生长受限、胎儿窘迫和早产在高龄组的发生率显著增高(P0.05)。结论高龄初产妇妊娠期并发症和胎儿异常的发生率增高。     

辅助生殖技术单胎妊娠结局分析

目的:研究辅助生殖技术(ART)与自然受孕两种不同受孕方式单胎妊娠的妊娠结局。方法:回顾分析2009年1月1日至2017年12月31日在广州医科大学附属第三医院住院分娩的妊娠≥20周的单胎妊娠病例资料。按受孕方法分为ART组及自然妊娠组,分析两组母儿结局,再按是否为高龄妊娠,比较ART组及自然妊娠组的母儿结局。结果:ART组孕妇的平均年龄、初产妇、定期产检、非足月胎膜早破(PPROM)、羊水量异常、子痫前期、妊娠期高血压、妊娠合并血小板减少症、妊娠期糖尿病、糖尿病合并妊娠、前置胎盘、胎盘植入/粘连、产后出血、剖宫产分娩、产钳/吸引产助产、人工剥离胎盘、药物/机械性引产、流产、胎儿窘迫及胎儿为男性发生率均高于自然妊娠组,ART组的住院天数更长,分娩孕周更低,转诊重症监护病房(ICU)、急性器官衰竭发生风险较低,ART组围产儿平均体重高于自然受孕组。高龄妊娠孕妇中,ART组的妊娠期糖尿病、剖宫产分娩发生风险增加。非高龄妊娠孕妇中,ART组子痫前期、妊娠期高血压、妊娠期糖尿病、糖尿病合并妊娠、流产、PROM、羊水量异常、前置胎盘、胎盘植入/粘连、产后出血、胎儿窘迫、人工剥离胎盘、药物/机械性引产发生风险增加。ART组较自然妊娠组钳产/吸引产风险均增加,产妇转诊ICU及非规律产检发生风险均降低,差异均有统计学意义(均P<0.05)。结论:ART受孕单胎妊娠并发症及新生儿不良结局发生率高于自然妊娠组孕妇,但其更注重孕期产检;在非高龄妊娠孕妇中,ART组母儿不良结局风险增加,而高龄妊娠孕妇中,ART组母儿不良结局风险增加不明显。     

溶脲脲原体感染与妊娠结局及新生儿并发症

目的 :探讨溶脲脲原体 (Ureaplasma urealyticum,UU)感染与妊娠结局及新生儿并发症的关系。方法 :对 91 5位孕妇 ,进行宫颈粘液 UU的液体培养基分离培养检测 ;对其中所产的 6 31例新生儿咽分泌物做 UU分离培养 ,并按婴儿感染与否分为感染组与未对照组。结果 :感染组 (2 93例 )较对照组 (338例 )的胎膜早破、胎儿宫内窘迫以及新生儿并发症的发生率均明显增多。新生儿并发症包括新生儿咽疱疹、新生儿发热、新生儿肺炎和新生儿结膜炎等。结论 :UU感染与不良妊娠结局密切相关 ,与新生儿并发症的关系值得进一步研究。加强孕妇的卫生保健对于降低感染率、改善不良妊娠结局和新生儿并发症有重要意义     

Risk factors for cesarean section of primiparous women aged over 35 years

BACKGROUND: To determine the perinatal outcome of pregnancy in primiparous women over 35 years of age and to evaluate determinants predicting cesarean delivery in these women. METHODS: Two hundred and seven mothers aged at least 35 years (1.8% of the total deliveries) delivered in the Department of Obstetrics and Gynecology between 1995 and 2000. These women were matched with women aged 20-29 years according to gravidity. Multiple logistic regression analysis was used to evaluate the risk of cesarean delivery, with controls for possible confounding factors. RESULTS: Cesarean section was 2.09-fold more prevalent among the older than among the younger women; the difference being significant (odds ratio, OR=3.36, 95%CI 2.22-5.09; p<0.001). The advanced maternal age was associated with a significantly higher rate of assisted reproductive techniques involvement (OR 6.54; 95%CI 3.54-12.38; p<0.001). The difference between the rates of preeclampsia in the two groups did not reach the level of significance (OR 1.85; 95%CI 1.02-3.34; p=0.056). There were no significant differences in perinatal outcome between the two groups. The logistic regression model demonstrated an increased risk of cesarean section among the primiparous women aged over 35 years. CONCLUSIONS: The risk of cesarean section at this advanced age is 6.54-fold. The determinants are included in the pregnancy, delivery and neonatal outcome.     

Outcomes of mature primiparas in an out-of-hospital birth center

This is a retrospective chart review of perinatal outcomes of all primiparas over the age of 24 delivering at Maternity Center Associates, an out-of-hospital birth center, from January 1985 through May 1988 (N = 228). Chi-square analysis was used to determine whether mature primiparas, aged 35 to 43 (n = 27), had significantly more adverse outcomes than younger primiparas, aged 25 to 34 (n = 201). There was a significant difference between the groups in rate of transfer to hospital; however, there were no significant differences in rate of cesarean section, infant birth weight, apgar scores, and length of second stage labor. Implications for practice and future study are examined.     

Obstetric and perinatal outcome of women para > or = 5 including one lower segment cesarean section

OBJECTIVE: To study the prevalence of antenatal, intrapartum and postnatal complications and their perinatal outcome in women who are delivering for the 6th time and have also had one cesarean section. METHODS: The records of all women para > or = 5 with one previous cesarean section (n = 238) delivered at King Fahd Hospital of the University between the January 1 1994 and December 31 2000 were reviewed and compared with women who delivered at the hospital in the year 2000 (n = 2470). This data was analyzed for the peripartum and perinatal outcome. RESULTS: The incidence of malpresentation was higher in the study group. The incidence of uterine rupture and uterine scar dehiscence was significantly higher in the study group, but there was no perinatal or maternal death associated with this and in all cases the uterus was preserved. More women managed to deliver vaginally after the cesarean section in the grandmultiparous women compared with the women in the control group (81.5% vs 63.0%) P < 0.00006, where the cesarean section rate was significantly higher (P < 0.02). There were no significant differences in the incidences of preterm labor, lethal malformations, stillbirths and neonatal deaths in the two groups of women. There was one case of cesarean hysterectomy in each group due to placenta accreta and atonic postpartum hemorrhage, and one maternal death in the control group. CONCLUSION: Grandmultiparous women with one previous cesarean section have an increased risk of operative delivery, scar dehiscence, but there is no increase in perinatal or maternal mortality.     

Factors associated with adverse perinatal outcome in the Term Breech Trial

BACKGROUND: In the Term Breech Trial, the risk of adverse perinatal outcome was lower with planned cesarean section versus planned vaginal birth. We undertook secondary analyses to determine factors associated with adverse perinatal outcome. STUDY DESIGN: By using multiple logistic regression analyses, we determined the effect of prelabor cesarean section, cesarean section during early labor, cesarean section during active labor versus vaginal birth, and other factors, on adverse perinatal outcome. For 1384 fetuses delivered after labor, we determined the effect of variables associated with labor on adverse perinatal outcome. RESULTS: The risk of adverse perinatal outcome was lowest with prelabor cesarean section (odds ratio [OR]=0.13) and highest with vaginal birth. For those delivered after labor, labor augmentation (P=.007), birth weight less than 2.8 kg (P=.003), and longer time between pushing and delivery (P<.001) increased the risk, whereas the presence of an experienced clinician at delivery (P=.004) reduced the risk of adverse perinatal outcome. CONCLUSION: Breech infants at term are best delivered by prelabor cesarean section.     

Complications associated with the macrosomic fetus

A retrospective study was done on 525 infants who weighed more than 4,500 g. The rates of grand multiparity, diabetes mellitus, pregnancy-induced hypertension, deliveries in women over 35 years of age, placenta previa and weight gain of more than 15 kg were higher than in a control group weighing 2,500-4,000 g. The rates of delivery with instruments and cesarean section were also significantly higher. The main indication for cesarean section in the study group was cephalopelvic disproportion, while in the control group it was repeat cesarean section. Rates of postpartum hemorrhage, shoulder dystocia, oxytocin augmentation of labor and tears in the birth canal far exceeded those in the control group. Maternal and fetal morbidity and perinatal mortality were significantly higher than in the control group. The complications were due to a difficult second stage of labor. Delivery of the macrosomic fetus by cesarean section is highly recommended except for the subgroup of women who already delivered a macrosomic child.     

Cesarean versus vaginal delivery in abruptio placentae associated with live fetuses

In order to test the relative effectiveness of cesarean section and vaginal delivery in mild abruptio placentae associated with live fetuses, 23 consecutive patients were delivered vaginally and 18 by cesarean section over an 18-month period at the University of Ife Hospital in Nigeria. The perinatal mortality of the vaginal delivery group (52.2%) was significantly greater than that of those delivered by cesarean section (16.7%) (P greater than 0.02; less than 0.05; chi 2 test). The 1-min Apgar score test was also significantly greater than that of those delivered by cesarean section (P greater than 0.001). These differences have been attributed to the admission-to-delivery interval, which was significantly longer in the vaginal delivery group (12 h vs. 2 h). It is concluded that cesarean section is clearly superior to vaginal delivery in the management of abruptio placentae associated with live fetuses.     

不同分娩方式对低危孕产妇分娩结局及卫生经济学指标的影响

目的探讨不同分娩方式对低危孕产妇分娩结局及卫生经济学指标的影响。方法对2002年9月至2007年4月北京协和医院分娩的3751例孕37-41周^＋6的低危孕产妇的资料进行回顾性分析,按分娩的干预方式不同分为3组：择期引产组（包括药物及手术引产）501例、择期剖宫产组1634例和自然临产组1616例,分别对3组孕产妇的一般情况及住院费用以及分娩结局（产后出血、产褥病率、尿潴留、输血情况、切口愈合情况、产时副损伤）、新生儿Apgar评分情况等进行统计比较。结果（1）一般情况分析：自然临产组孕产妇住院天数（4．8d）与择期引产组（6．3d）及择期剖宫产组（6．3d）比较,差异有统计学意义（P〈0．01）;择期剖宫产组孕产妇住院费用（3472元）明显高于择期引产组（3201元）及自然临产组（2293元）,分别比较,差异有统计学意义（P〈0．01）,尤其是择期引产组中的剖宫产患者住院费用明显高于择期剖宫产组及自然临产组中的剖宫产患者,分别比较,差异均有统计学意义（P〈0．01）。（2）产时及产后并发症总发生率：孕产妇产时及产后并发症总发生率分别是择期引产组为12．4％、择期剖宫产组为0．9％,自然临产组为6．8％。（3）产后出血（≥500ml）发生率：择期引产组、择期剖宫产组和自然临产组分别为3．0％（15／501）、0．6％（9／1634）和1．2％（19／1616）,3组分别比较,差异有统计学意义（P〈0．01）。（4）尿潴留发生率：择期引产组、择期剖宫产组和自然临产组分别为4．6％（23／501）、0和3．3％（54／1616）,择期剖宫产组尿潴留发生率低于择期引产组与自然临产组（P〈0．01）,择期引产组与自然临产组比较,差异无统计学意义（P〉0．01）。（5）有无分娩中或产后输血：择期引产组、择期剖宫产组和自然临产组率孕产妇有输血者分别为2．0％（10／501）、0．1％（1／1634）和0．4％（6／1616）,3组分别比较,差异有统计学意义（P〈0．01）。（6）产时副损伤：择期引产组、择期剖宫产组和自然临产组产时副损伤发生率分别为0．6％（3／501）、0和0．4％（7／1616）,3组分别比较,择期剖宫产组低于其他两组（P〈0．01）,择期引产组与自然临产组比较,差异无统计学意义（P〉0．01）。（7）切口延期愈合：择期引产组、择期剖宫产组和自然临产组分别为0．8％（4／501）、0和0．2％（4／1616）,3组分别比较,差异有统计学意义（P〈0．01）。（8）产褥病率：3组间相互比较,差别无统计学意义（P〉0．01）。（9）新生儿窒息发生率：择期引产组、择期剖宫产组和自然临产组分别为1．2％（6／501）、0．1％（1／1634）和1．0％（17／1616）,择期剖宫产组与其他两组分别比较,差异均有统计学意义（P〈0．01）,择期引产组与自然临产组比较,差异无统计学意义（P〉0．01）。结论择期引产会增加孕产妇产后出血、分娩中或产后输血的机会,且没有降低产妇尿潴留、新生儿窒息的发生率;择期剖宫产是相对安全的分娩方式,对孕产妇分娩并发症的发生没有不良影响,但会明显增加住院费用。     

Effect of delivery method on outcomes in the very low-birth weight breech infant: is the improved survival related to cesarean section or other perinatal care maneuvers?

The perinatal mortality rate among very low-birth weight infants has been decreased by 20% during the last 4 years of the 1973 to 1980 period here reported. The concurrent increase in the cesarean section rate from 11.9% to 49.1% during the same time frames has been assumed to be responsible for the improved outcome. The changes were most marked in the extremely low-birth weight group (less than 1,000 gm). The survival rates and cesarean section rates were examined among infants of similar birth weight and gestational age in the vertex presentation, in the same time frames. A similar or greater reduction in mortality rate (from 85% to 45%) was noted in the very low-birth weight vertex infants, whereas the cesarean section rate remained minimally and not significantly increased (14.2% to 22.2%). The interpretation of this finding is by no means clear but must include the hypothesis that the increased cesarean section rate may be incidental and in no way related to the improved outcome. The most statistically significant determinants of outcome remain birth weight and gestational age strata, with no significant difference in outcomes when the extremely low-birth weight group is analyzed separately from the entire very low-birth weight group. As yet unidentified perinatal care practices, other than cesarean section, may be more likely to affect outcome in this high-risk group.     

Re-evaluation of the obstetrical risk for the older primipara

The obstetric data relating to 92 older primiparas (OP) treated as regular obstetric patients and data relating to 92 older multiparas (OM) are compared to a previous study of 98 OP, which led to the conclusion that OP should not be managed as high-risk patients during gestation. No difference was found between the two periods regarding complications of pregnancy, gestational age and birth weight, onset of labor, perinatal morbidity and mortality. Nevertheless, cesarean deliveries were significantly higher in the study group. It seems that the conservative attitude towards OP during pregnancy is justified, but at labor, more rigid indications for cesarean section should be applied to establish objective patient care.     

2000年至2009年足月单胎活产新生儿出生体重与剖宫产率的关系

目的 了解首都医科大学燕京医学院附属密云医院妇产科10年间分娩的足月单胎活产新生儿出生体重,分析其变化趋势及与剖宫产率的关系,为加强孕期营养指导、降低剖宫产率提供依据。 方法选取2000年1月1日至2009年12月31日在首都医科大学燕京医学院附属密云医院妇产科分娩的足月单胎活产新生儿,对其出生体重、巨大儿发生率及剖宫产率变化趋势进行分析。结果 (1)10年间共分娩足月单胎活产新生儿14 716人,男婴7642人,女婴7074人,男女比例为1.08.：1。10年间分娩巨大儿共1773人,构成比12.0％,低出生体重儿180人,构成比1.2％。(2)10年间足月单胎活产新生儿出生体重范围1200～5850 g,平均出生体重(3422±447)g,年度间平均出生体重呈上升趋势,差异有统计学意义(F= 15.337,P＜0.01)。(3)年度间巨大儿构成比呈上升趋势,差异有统计学意义（x2=125.285,P＜0.01）。(4)年度间剖宫产率呈逐年上升趋势,自2000年的49.9％上升至2009年的57.1％,差异有统计学意义(x2=180.883,P＜0.01)。(5)10年间随足月单胎活产新生儿平均出生体重上升,剖宫产率自＜2500 g的52.2％上升至4500 g～的85.4％,差异有统计学意义（x2=518.519,P＜0.01）。 结论 足月新生儿出生体重与剖宫产率有密切关系,应重视加强围产保健和孕期营养指导。