30年早产发病趋势及产科因素抽样分析

【目的】探讨早产发生率及随年代变化的趋势。【方法】对我院从1969～1998年的分娩资料进行回顾性分析，并抽取逐年8月份的早产病例共253例做为样本，分为3个年代进行产科因素的比较。【结果】①30年早产发生率为4.72%(95%置信区间4.16，5.32)；②早产发生率不随年代发展出现明显变化，且无明显季节倾向性；③1989～1998年度剖宫产率较1969～1978年及1979～1988年两个年度明显升高(P<0.05)。④随着年代发展，早产病例中胎膜早破的比例明显增高；无明显合并症及并发症的不明原因早产病例有显著下降；1989～1998年度胎儿宫内窘迫及体外受精与胚胎移植术后妊娠(IVF-ET)病例呈明显上升趋势(P<0.05)。⑤早产儿分娩孕周有明显后移倾向，出生体重增加显著，明显表现在1989～1998年与前两个年度的比较(P<0.05)。但围产儿死亡率无明显下降。【结论】早产发生率无明显下降，仍是产科一大难题。剖宫产率的上升没有降低早产儿死亡率。胎膜早破逐渐成为早产最重要因素，IVF是早产新的高危因素。

The Morbidity Trend of the Preterm Delivery in Thirty Years and Sampling Analysis of the Obsterical Factors

【Objective】 To investigate the morbidity trend of the preterm delivery.【Methods】 A retrospective study was done on the delivery data in our hospital from 1969 to 1998. Select the cases on annual August as the sam pling units, and divided those 253 cases into three decade groups, to analyze th e obsterical factors affecting the preterm delivery.【Results】 ① The morbidity of the preterm delivery in thirty years was 4.72%(95% CI 4.16, 5.32). ② The re were no obvious changes of the morbidity among the years, and had no seasonal aggregation. ③ The cesarean section rates in the third decade increased signif icantly than those in former two decades (P<0.05). ④ As time goes on, the i ncidence of premature rupture of membrane increased, and that of the preterm del ivery with no obvious complication decreased. The cases with the intrauterine fe tal distress and IVF-ET in the third decade were significantly increased. ⑤ Th e gestation age and birth weight increased significantly, especially in the thir d decade, but the neonatal mortality had no obvious change. 【Conclusions】 Ther e was no reduction of the morbidity of the preterm delivery, further studies sho uld be emphasized. It seems unlikely the increased of cesarean section rates wil l reduce the neonatal mortality. PROM is important factors affecting the preterm delivery, and the IVF women may be at higher risk of preterm delivery.