妊娠期糖代谢异常孕妇分娩时机和方式的探讨

目的:探讨妊娠期糖代谢异常孕妇的分娩时机和方式,以降低孕产妇和围产儿并发症。方法:对2006年8月至2008年7月中山大学附属第三医院产科住院分娩的302例糖代谢异常患者的临床资料进行回顾性分析。结果:孕周<37周组和>40周组孕妇的胎儿窘迫、剖宫产、新生儿窒息、新生儿高胆红素血症的发生率均高于37～40孕周组(P<0.05);剖宫产与阴道分娩组产后出血、新生儿窒息、新生儿黄疸的发生率均无统计学意义(P>0.05),但剖宫产组中孕妇血糖未控制、子痫前期、胎儿窘迫、巨大儿所占的比例高于阴道分娩组(P<0.05)。结论:妊娠期糖代谢异常孕妇分娩孕周以37～40周为宜;妊娠期糖代谢异常孕妇可阴道试产,但血糖未控制、并发子痫前期、巨大儿及出现胎儿窘迫时宜剖宫产终止妊娠。

Exploration on delivery opportunity and modes of women with abnormal glucose metabolism during pregnancy

Objective:To explore the delivery opportunity and modes of women with abnormal glucose metabolism during pregnancy,decrease the complications of mothers and infants.Methods:Clinical data of 302 women with abnormal glucose metabolism during pregnancy delivering in the hospital from August 2006 to July 2008 were analyzed retrospectively.Results:The incidences of fetal distress,cesarean section,neonatal asphyxia and hyperbilirubinemia in gestational weeks<37 weeks group and gestational weeks>40 weeks group were significantly higher than those in 37～40 gestational weeks group(P<0.05).There was no significant difference in incidences of postpartum hemorrhage,neonatal asphyxia and hyperbilirubinemia between vaginal delivery group and caesarean section group(P>0.05),but the proportions of uncontrolled blood glucose,preeclampsia,fetal distress and fetal macrosomia in caesarean section group were higher than those in vaginal delivery group(P<0.05).Conclusion:The suitable delivery opportunity is 37～40 gestational weeks,women with abnormal glucose metabolism during pregnancy may adopt vaginal delivery,but those with uncontrolled blood glucose,preeclampsia,fetal distress and fetal macrosomia should terminate pregnancy by caesarean section.