多因素分析住院分娩孕妇不良妊娠结局的危险因素

目的: 通过对住院分娩孕妇不良妊娠结局的风险因素分析，探讨妊娠期管理。方法: 选取2016年8月至2017年5月于航天中心医院住院分娩的排除孕前合并症患者872例，采集孕前相关信息、孕期检查数据，以及分娩孕周、分娩方式、新生儿出生体重、妊娠期常见并发症等数据。对不良妊娠结局的风险因素进行多因素回归分析，根据风险因素探讨管理方案。结果： 妊娠高血压风险因素为高龄、孕前高BMI值、体重增长过多、晚期三酰甘油水平增高；妊娠期糖尿病风险因素为高龄、孕前高BMI值、体重增长不足；早产主要风险为妊娠高血压、胎膜早破，微量元素铜水平升高可以减低早产风险；产后出血主要风险因素为高孕前体重、胎儿体重大；足月分娩巨大儿的主要风险为孕期体重增长过多、孕前高BMI、分娩孕周延长；有妊娠高血压、年龄≥35岁、有不良孕产史、胎膜早破者剖宫产风险增加。结论： 围妊娠管理建议在适宜的年龄妊娠，控制孕前体重，适量补充微量元素，孕期控制体重增长速度在适宜范围，积极筛查干预生殖道感染。

Multivariate analysis of risk factors for adverse pregnancy outcomes in hospitalized pregnant women

Objective: To explore pregnancy management through risk factors analysis of adverse pregnancy outcomes. Methods: A cohort study was conducted on 872 patients excluded prepregnancy complications from August 2016 to May 2017. The following data on pregnancy and adverse pregnancy outcomes were collected, i.e. pre-pregnancy related information, pregnancy examination data, gestational week, newborn birth weight and common complications during pregnancy. The risk factors of premature birth, postpartum hemorrhage, macrosomia, low birth weight and cesarean section were analyzed by multivariate regression analysis, and the management plan was proposed according to the risk factors. Results: The risk factors of gestational hypertension were advanced age, high BMI before pregnancy, excessive weight gain and increased triglyceride level in late stage. Risk factors for gestational diabetes were advanced age, high pre-pregnancy BMI and insufficient weight gain. The main risk factors of premature birth were gestational hypertension and premature rupture of membranes. The main risk factors of postpartum hemorrhage are high pre-pregnancy weight and large fetal weight. The main risks of giving birth to giant baby at full term were excessive weight gain during pregnancy, high BMI before pregnancy and prolonged gestational period.Conclusion: The management of peri-pregnancy was suggested as that pregnancy should be conducted at an appropriate age, pre-pregnancy weight should be controlled, microelements should be added appropriately, weight growth rate should be controlled in an appropriate range during pregnancy, and reproductive tract infection should be actively screened and controlled.［Key words］adverse pregnancy outcomes; risk factors; multivariate analysis