470例早产相关因素及早产儿结局分析

目的:探讨海南地区早产发生现状及不同孕周、不同类型早产儿的结局。方法:选择2010年1月1日～2012年5月31日在海南医学院附属医院住院分娩的孕28周～36+6周早产产妇470例为研究对象。结果:①早产发生率:早产发生率为29.03%(470/1 619)。②早产发生孕周:平均分娩孕周33.5周,其中早期早产发生率为15.11%(71/470),中期早产发生率19.87%(94/470),晚期早产发生率64.89%(305/470)。③早产发生的原因:在早产的发生原因排序中,医源性早产占首位,其次为PPROM早产和自发性早产。医源性早产中前5位原因分别是双胎及其相关并发症50例(18.58%),前置胎盘44例(16.35%),子痫前期39例(14.49%),子宫疤痕33例(12.26%),胎盘早剥9例(3.34%)。④不同孕周的早产儿结局比较:早产儿并发症的发生与孕周相关,早期、中期、晚期早产儿的并发症(新生儿窒息、肺部感染、颅内出血、肺透明膜病)比较,均具有统计学差异(P<0.05)。⑤不同原因的早产儿结局比较:在医源性早产、PPROM及自发性早产中,围生儿死亡率比较无统计学差异(P>0.05)。肺部感染及颅内出血的发生率在上述原因的早产组中无统计学差异(P>0.05);而新生儿窒息及NRDS发生率在上述各种原因的早产组中存在统计学差异(P<0.05)。结论:早产儿的并发症及死亡率与孕周密切相关,<32周的早期早产儿死亡率和并发症明显增高。减少医源性早产,积极预防PPROM及自发性早产的发生是降低早产发生率的重要因素。

Analysis of the related factors and neonatal outcomes of 470 cases of preterm deliveries

Objective:To explore the situation of premature delivery and the outcomes with different gestational age and different types of preterm infants in Hainan province.Methods:From January 1 2010 to 31 May 2012,470 preterm births at 28-36+6pregnant weeks were selected in Hainan Medical Affiliated Hospital hospitalized delivery as research objects.Results:①The rate of premature delivery: the rate of premature delivery was 29.03%(470/1 619).②Gestational age of premature delivery: the average gestational age at delivery was 33.5 weeks,the rate of early preterm was 15.11%(71/470).The rate of medium-term preterm was 19.87%(94/470);The rate of late preterm was 64.89%(305/470).③The reason of premature delivery: the cause of premature delivery,iatrogenic preterm topped the list,followed by the PPROM premature delivery and spontaneous premature delivery.5 reasons were iatrogenic preterm twins and their associated complications the 50 cases(18.58%),44 cases(16.35%) with placenta previa,39 cases(14.49%) with preeclampsia,33 cases(12.26%) with uterine scar,9 cases(3.34%) with placental abruption.④Comparing of the outcomes in different gestational age premature delivery: occurrence of the complications of premature delivery was related with gestational age.There were significant differences in early,middle,and late preterm infants complications(neonatal asphyxia,lung infection,intracranial hemorrhage,hyaline membrane disease)(P<0.05).⑤Comparing the outcomes of different causes in premature delivery: there was no significant difference in iatrogenic preterm,PPROM and spontaneous preterm in terms of perinatal mortality(P>0.05).There was no significant difference in pulmonary infection and the incidence of intracranial hemorrhage among the above premature groups(P>0.05).There were significant differences in terms of neonatal asphyxia and NRDS in the various premature delivery groups(P<0.05).Conclusion:The premature delivery complications and mortality of children are closely related with gestational age.Those less than 32 weeks are with higher neonatal mortality and complications.Reducing iatrogenic preterm birth and actively preventing,predicting PPROM and spontaneous preterm delivery are key factors in reducing the incidence of preterm dilivery.