395例巨大儿临床分析

巨大儿是产科常见的胎儿并发症之一 ,是难产、新生儿产伤的高危因素 ,近年来有明显增加趋势 ,是产科医生面临的又一重要问题。本文对 395例巨大儿做回顾性分析 ,探讨巨大儿产前预测及分娩方式 ,减少母儿并发症。资料与方法1 一般资料 :1 996年 1月～ 2 0 0 0年 1 2月 5年间在我院分娩的骨盆、身高正常的产妇共 4 72 9例 ,其中巨大胎儿395例 (出生体重≥ 4 0 0 0g) ,发生率为 8 4 % ;正常体重儿4 334例 (出生体重≥ 2 5 0 0g ,4 0 0 0g) ,发生率为 91 6 % ;孕妇年龄最小 2 3岁 ,最大 39岁 ,2 5～ 34岁占 82 2 % ;初产妇 32 2例 ,占 81 5 …     

"新生儿游泳"在产科临床应用的探讨

目的　探讨在住院期间新生儿“游泳”后部分指标变化的临床意义。　方法　将 377例正常新生儿按分娩顺序分为观察组 (游泳组 ) 2 2 3例 ,其中阴道分娩 12 7例 ,剖宫产 96例 ;对照组 (单纯沐浴组 ) 15 4例 ,其中阴道分娩 10 9例、剖宫产 4 5例。测定两组新生儿的出生体重、出院时体重、胎便初排时间、胎便转黄时间。　结果　两组阴道分娩、剖宫产新生儿出生时体重无明显差异 (P >0 .0 5 ) ,观察组新生儿出院时阴道分娩者平均体重 (32 90± 35 0 ) g,剖宫产者平均体重 (35 10± 4 0 0 ) g;对照组新生儿出院时体重阴道分娩者平均 (30 90± 380 ) g,剖宫产者平均 (3170± 4 80 ) g,两组比较差异有显著性 (P<0 .0 1)。观察组胎便转黄时间 ,阴道分娩者平均 (39.2± 15 .9) h,剖宫产者平均 (39.0± 13.6 ) h,对照组胎便转黄时间 ,阴道分娩平均 (4 8.0± 19.4 ) h,剖宫产平均 (5 5 .7± 2 5 .1) h,两组比较差异有显著性 (P<0 .0 1)。两组胎便初排时间差异亦有显著性 (P<0 .0 5 )。　结论　新生儿游泳有助于新生儿的生长发育。     

巨大胎儿与临床关系

文献报道巨大胎儿的定义是出生体重≥4000g,其发生率为6%～10%。巨大儿分娩时常有下列问题:巨大胎儿的认别,分娩方式的选择,阴道分娩时的滞产、肩难产,母儿产伤,使母儿发病率及死亡率增高。该院1987年1月至12月共有孕妇100 746例,分娩婴儿101 931人,其中8 591例达到出生体重≥4 000g的巨大胎儿标准。     

孕妇体重与剖宫产、产程持续时间、宫颈扩张速度之间的联系

为了探求孕妇体重与引产过程中产程持续时间 ,宫颈扩张速度以及剖宫产终止妊娠的关系 ,作者选择了 5 0 9例引产孕妇 ,采用一致的待产程序和手术指征 ,观察孕妇的年龄、体重、孕周、种族、产次、引产指征等项目 ,在排除产妇年龄、宫颈起始状态及糖尿病等干扰因素后比较不同的体重水平剖宫产率、宫颈扩张速度、产程持续时间之间的差异。结果 :总的剖宫产率为 2 0 % ,剖宫产组孕妇的平均体重大于阴道分娩组 ,分别为 97± 2 9kg和 87± 2 2kg,初产妇体重每增加 10kg ,剖宫产率就上升 2 5 % (OR1.17;95 %CI1.0 4 ,1.2 8)。经阴道分娩的病例中初…     

双胎妊娠116例分娩时机及分娩方式的探讨

双胎妊娠的孕妇并发症多 ,新生儿窒息、病死率高。积极防治妊娠期各种并发症 ,选择有利分娩的时机及方式对提高双胎围生儿存活率有重要意义。本文就 116例双胎妊娠资料进行回顾性分析 ,报道如下。1　临床资料1 1　一般资料　 1996年 1月至 2 0 0 0年 12月间我院分娩总数 72 5 0例 ,双胎 116例 ,占 1 60 %;单胎 713 1例 ,占98 3 6%。双胎与单胎发生率比为 1∶61 5 0。1 2　双胎分娩方式及剖宫产指征　阴道顺产 5 9例 ,占5 0 86%;阴道助产分娩者共 17例 ,占 14 66%;剖宫产 4 0例 ,占 3 4 48%。主要剖宫产指征有 :①第一胎儿非头位者原则上…     

超声测量胎儿腹围预测新生儿出生体重的研究

目的探讨超声测量胎儿腹围在预测新生儿出生体重和诊断巨大儿中的价值。方法在孕妇分娩前1周超声测量胎儿腹围,追踪胎儿的出生体重,分析胎儿腹围与出生体重的关系。结果(1)共检测1475例单胎孕妇胎儿,胎儿腹围与出生体重呈直线正相关关系,r为0.85(P<0.01)。(2)胎儿腹围<34cm者中无一例巨大儿;胎儿腹围<35cm有1007例,99.7%的新生儿平均出生体重<4000g;胎儿腹围在35～35.9cm有206例,新生儿平均出生体重为(3691±277)g,其中14.6%(30例)的新生儿出生体重≥4000g;胎儿腹围在36～36.9cm有149例,其中51.0%(76例)的新生儿出生体重≥4000g,新生儿平均出生体重为(3957±256)g;胎儿腹围在37～37.9cm有64例,其中84.4%(54例)的新生儿出生体重≥4000g,平均出生体重(4205±250)g;胎儿腹围≥38cm有44例,新生儿平均出生体重≥4000g者为100%(44例),平均出生体重为(4489±267)g。(3)1475例中有811例孕妇行剖宫产术(55.0%),新生儿出生体重为4000～4500g者,剖宫产率为71.4%(125/175),出生体重≥4500g者,剖宫产率为93.8%(30/32),均显著高于新生儿出生体重<4000g的剖宫产率(P<0.01)。结论超声测量胎儿腹围可以预测新生儿出生体重。胎儿腹围与胎儿体重呈高度直线正相关。胎儿腹围<35cm提示发生巨大儿的可能性极低;≥37cm提示巨大儿的可能性大。     

阴道分娩与剖宫产对母儿血清胃泌素水平的影响

目的　探讨经阴道分娩与剖宫产对母血和新生儿脐血胃泌素水平的影响。　方法　采用放射免疫法测定择期剖宫产、阴道分娩的孕妇及产后 3～ 5 d的产妇各 2 0例的血清胃泌素水平。同时测定 2 0例经阴道产儿和 2 2例剖宫产儿的脐血胃泌素水平。　结果　分娩发动后母血清胃泌素水平为 (10 8.2 3± 2 4.39) ng/ L ,较未发动宫缩的足月孕妇血清胃泌素水平 (78.2 8± 31.13) ng/ L升高(P<0 .0 5 ) ;产后 3～ 5 d母血清胃泌素水平为 (143.33± 35 .6 1) ng/ L ,较产前明显升高 (与阴道分娩和剖宫产相比分别为 P<0 .0 5 ;P<0 .0 1)。经阴道产儿脐血胃泌素水平为 (138.37± 2 0 .2 8) ng/ L ,明显高于剖宫产儿脐血胃泌素水平 (10 1.2 3± 18.16 ) ng/ L (P<0 .0 5 )。　结论　阴道分娩有利于新生儿胃肠功能的成熟与完善     

巨大胎儿相关因素及预后340例临床分析

新生儿出生体重（NBW）≥4000g称为巨大胎儿,NBW≥4500g称为特大胎儿,属高危妊娠。近年来巨大胎儿发生率逐渐增高,巨大胎儿分娩并发症及围生儿病发率明显增加。现对我院住院分娩的340例巨大胎儿进行回顾性临床分析,探讨诊断巨大胎儿的相关因素,分析如下。     

巨大胎儿104例临床特点及分娩结局

为提高临床产前诊断巨大胎儿的准确性 ,对我院近 3年来巨大胎儿 (巨大儿 )及分娩期的临床特点、分娩结局 ,作一回顾性分析 ,指导正确处理产程 ,选择恰当的分娩方式 ,确保母婴安全。1　资料与方法1.1　一般资料我院 1998年 1月至 2 0 0 0年 12月分娩新生儿总数 16 0 1例 ,其中巨大胎儿 113例 ,除以臀位、母亲有严重并发症及产前诊断为巨大胎儿为指征选择性剖宫产的 9例外 ,其余10 4例均为单胎头位 ,全部进行了试产 (巨大胎儿组 )。选择近巨大胎儿分娩之后 1～ 2天内出生体重 <4 0 0 0g的正常足月单胎头位分娩的 10 4例作为对照组。1.2　方法…     

对有剖宫产史孕妇应用米索前列醇引产的评价

曾有几篇关于有剖宫产史孕妇应用米索前列醇引产导致子宫破裂的报道 ,最近一篇文献报告子宫破裂发生率高达 6 % ,但作者的经验表明并发症的发生率并无如此之高。本研究的目的是比较分析有剖宫产史孕妇和无剖宫产史孕妇应用米索前列醇引产所致并发症的发生率。作者选择 1996年 1月至 1998年 12月对单胎胎儿存活应用米索前醇引产的孕妇作为基础资料作分析 ,引产用药方法为每 4小时阴道内置米索前列醇 5 0 μg共 6次。回顾性比较分析有剖宫产史孕妇与无剖宫产史孕妇引产后的分娩形式、分娩并发症、新生儿出生体重、新生儿出生 5分钟 Apgar评分…     

The incidence of foetal macrosomia and method of delivery for a two-year period in the University Hospital of Obstetrics and Gynecology Maichin Dom--Sofia

The authors carried out a retrospective study on the incidence of foetal macrosomia and the method of delivery on the 6157 consecutive births for a two-year period in the University Hospital of Obstetrics and Gynecology "Maichin Dom"- Sofia, Bulgaria. The incidence of foetal macrosomia (birth weight > 4000 g) among these births was 4,45% (274/6157 births). There was a coincidence between the admission diagnosis Macrosomia and the birth weight only in 8% of the cases. By Cesarean Section were delivered 117 macrosomic babies (42,7%): elective cesarean section had 89 patients - 32,48% (89/274) and emergency Cesarean section was done in 28 cases -10,2% Vaginal delivery had 157 patients - 57,3%. In this group 136 patients (86,33%) had normal vaginal delivery and 21 (13,37%) had operative vaginal delivery. (vacuum extractor, forceps, manual removal of the placenta). The authors found that the highest incidence of birth trauma was found in the cases where operative vaginal delivery was undertaken.     

Birth trauma in insulin-dependent diabetic pregnancies.

Infants of insulin-dependent diabetic mothers are considered to be at high risk for birth trauma, presumably due to macrosomia. With current management of diabetes in pregnancy, including strict glycemic control, the rate and the severity of macrosomia should be decreased. The frequent use of ultrasound to assess fetal growth and weight and the use of cesarean delivery in case of fetal macrosomia should further decrease the risk for birth trauma in these infants. We therefore undertook this study to test the null hypothesis that with current management, insulin-dependent diabetic mothers have a rate of birth trauma similar to that of infants of nondiabetic mothers (normal glucose challenge test at 28 weeks' gestation) matched for gestational age at birth, presence or absence of labor, delivery method (vaginal versus cesarean), and race. We studied 118 insulin-dependent diabetic mothers (White classes B-RT) and 354 control subjects (three matches for each insulin-dependent diabetic mother). The rate of birth trauma was 3.4% in insulin-dependent diabetic mothers, not significantly different from controls (2.5%). Logistic regression analysis in which birth trauma was the dependent variable and diabetes, race, presence or absence of labor, mode of delivery (vaginal versus cesarean), infant weight, and infant head circumference were independent variables revealed that only vaginal delivery was a significant risk factor for birth trauma in infants in both groups (p = 0.01). Most frequently observed birth traumas were brachial plexus injury, facial nerve injury, and cephalohematoma. Of the three infants with brachial plexus injury (insulin-dependent diabetic mothers, two; controls, one), two were delivered with use of midforceps.(ABSTRACT TRUNCATED AT 250 WORDS)     

初产妇与经产妇巨大儿分娩方式比较

目的　探讨产次对巨大儿分娩方式的影响。方法　对 2 0 0 0年 1月～ 2 0 0 3年 12月在我院分娩巨大儿的 131例正常单胎头位产妇进行回顾性分析 ,比较初产妇 (n =10 0 )与经产妇 (n =31)巨大儿的分娩方式及母儿并发症 ,并分别与同期分娩正常体重儿的初产妇和经产妇进行比较。结果　与分娩正常体重儿的产妇比较 ,分娩巨大儿的初产妇及经产妇选择性剖宫产率均明显增高 (2 2 0 %VS 38 0 % ,P <0 0 1;14 9%VS 32 3% ,P <0 0 5 ) ;初产妇试产失败急诊剖宫产率也明显增高 (18 0 %VS 4 1 9% ,P <0 0 1) ,产后出血率增加 (0 4 %VS3 0 % ,P <0 0 5 ) ;经产妇阴道分娩成功率及母儿并发症与分娩正常体重儿的产妇间差异无显著性 (P >0 0 5 )。结论　估计胎儿体重低于 4 5 0 0g的低危产妇可给予阴道试产机会 ,初产妇应特别注意产程观察及产后出血的防治。巨大儿实施选择性剖宫产应慎重。     

Effects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery

OBJECTIVE: The aim of this study was to examine the effects of a policy of elective cesarean delivery for suspected fetal macrosomia on the incidence of brachial palsy and on the cesarean delivery rate. STUDY DESIGN: We performed a retrospective assessment of a policy that recommends cesarean delivery for macrosomia (fetal weight > or =4500 g). Fetal weight was estimated by palpation, and ultrasonographic weight estimation was carried out whenever macrosomia was suspected. RESULTS: During the 4 years of the study 16,416 deliveries resulted in 133 infants with macrosomia (0.8%). Macrosomia was suspected in 47 cases and confirmed by birth weight in 21 (45%). Antenatal estimation of fetal weight was carried out for 115 of the fetuses with macrosomia (86%). Macrosomia was correctly predicted in 21 of 115 cases (18.3%). Thirteen infants with undiagnosed macrosomia were delivered by emergency cesarean procedures, and 99 were delivered vaginally. Three infants with macrosomia (3%) and 14 infants without macrosomia (0.1%) sustained brachial plexus injury. Our policy prevented at most a single case of brachial palsy, and it contributed 0.16% to our cesarean delivery rate. CONCLUSIONS: A policy of elective cesarean delivery in cases of suspected fetal macrosomia had an insignificant effect on the incidence of brachial plexus injury. Its contribution to the rate of cesarean delivery was also small.     

The peri-partum management of pregnancies with macrosomic babies weighing > or =4,500 g at a tertiary University Hospital.

The management of fetal macrosomia diagnosed antenatally presents a dilemma to the obstetrician. We retrospectively reviewed the peripartum management of singleton pregnancies, which ended in the delivery of a macrosomic baby (birth weight >/=4,500 g) in our unit between 1995 and 1999. This was to determine first, the associated maternal and neonatal morbidity and second, whether the lack of consensual management in our unit influences outcome. Over the 5-year period, there were 380 macrosomic births out of 26,974 deliveries; an incidence of macrosomia of 1.4%. The mean birth weight was 4,697 +/- 330 g (range 4,500 - 5,560 g). The onset of labour was spontaneous in 234 (61.6%) cases, 120 (31.6%) were inductions and 26 (6.8%) were elective caesarean sections. Of the 354 planned vaginal deliveries, 233 (65.8%) were spontaneous, 62 (17.5%) were operative vaginal deliveries and 59 (16.7%) were emergency caesarean sections. There was no relationship between the rate of successful vaginal delivery and birth weight. There were 40 (13.6%) cases of shoulder dystocia compared with 0.9% in the non-macrosomic population (p < 0.001). Emergency caesarean sections and shoulder dystocia were significantly more common with babies weighing >/=5,000 g (28.9% vs 15.2%, p < 0.002 for caesarean section and 25.8% vs 11%, p < 0.001 for dystocia). We therefore recommend that where the estimated fetal weight is >5,000 g, an elective caesarean section should be considered. Variations in the care provided by different consultants did not have any effect on outcome. Induction for fetal macrosomia alone did not improve outcome but was associated with a significantly higher emergency caesarean section rate and should therefore be discouraged.     

Management of gestational diabetes

This review studies 100 pregnancies of gestational diabetic patients during the past 3 years. Seventy-seven per cent were delivered after the spontaneous onset of labor at term. The perinatal mortality rate was 1 per cent, comparing favorably with the general perinatal mortality rate for our hospital. The perinatal morbidity rate was 8 per cent; half of this morbidity caused by birth trauma secondary to macrosomia with difficult vaginal delivery. Excessive fetal size appeared to be strongly associated with a maternal history of macrosomia. This significant morbidity secondary to macrosomia suggests a more liberal use of cesarean section when the fetal weight is estimated to be greater than 9 lbs.     

Suspected big baby: a difficult clinical problem in obstetrics

BACKGROUND: Large for gestational age fetuses, also called macrosomic fetuses, represent a continuing challenge in obstetrics. METHODS: We review various problems with large for gestational age fetuses. We have performed a literature search, mainly through the database PubMed (includes the Medline database). The clinical problem is discussed from the primary care provider's, the patient's and the obstetrician's point of view. RESULTS: Macrosomia is arbitrarily defined as having a fetal weight of above the 90th percentile, a birth weight of above 4000 g or 4500 g, or a birth weight of over +2 standard deviation of the mean birth weight by gestational age. The diagnosis of macrosomia is difficult, both by palpation and symphysis fundus measurement; even with sophisticated sonographic measures. The combination of biparietal diameter, femur length and abdominal circumference appears to be no better than abdominal circumference alone. INTERPRETATION: Based on the literature, labor should not be induced in nondiabetic pregnancies. The best policy is to await spontaneous birth or to induce labor after 42 weeks completion. A great number of cesarean sections have to be performed to avoid a single case of plexus brachialis paresis resulting from a difficult shoulder delivery. Cesarean section should not be considered in nondiabetic pregnancies unless the estimated fetal weight is above 5000 g. In pregnancies complicated by diabetes mellitus there are reasons for selective induction of labor if macrosomia is suspected and for cesarean section if the calculated birth weight is above 4000 g. Each department should have a strategy to handle such a situation because the problem with the difficult shoulder delivery cannot be completely avoided. Different procedures of managing difficult shoulder delivery are described.     

505例巨大胎儿分析

目的 探讨巨大胎儿的产前诊断及分娩方式,降低母儿并发症。方法 回顾分析５０５例巨大胎儿诊断、分娩方式及并发症,并与单胎正常体重儿分娩情况进行比较。结果 巨大胎儿中双顶径（ＢＰＤ）＋胎骨长度（ＦＬ）〉１６．５ｃｍ者占８８．４６％,剖宫产组较阴道分娩组新生儿窒息率及产伤机会均明显降低,巨大胎儿与正常体重儿相比难产率明显升高。结论 ＢＰＤ＋ＦＬ〉１６．５ｃｍ可做为产前诊断巨大胎儿的一项可靠指标,对巨大胎     

非糖尿病性巨大儿175例临床特征及相关因素探讨

目的探讨非糖尿病性巨大儿及其母亲的临床特征及相关因素.方法通过本院近5年出生的175例非糖尿病性巨大儿或其母亲与随机选择同期出生的174例正常体重儿或其母亲的回顾性对照分析.结果非糖尿病性巨大儿的平均胎龄、体重、身高、双顶径及男性比例均显著高于对照组;其母亲的平均孕龄、年龄、身高、孕末期体重指数及围产期发病率、剖宫产率均显著高于对照组.结论非糖尿病性巨大儿是生长发育全面成熟且有生机活力的,以男性为多;其发生与其母亲孕龄、年龄、身高、产次等非糖尿病性因素有关,并导致其母亲围产期发病率、剖宫产率均显著增高;积极预防非糖尿病性巨大儿的发生是降低围产期发病率和提高产科质量的重要措施之一.