妊娠合并糖尿病患者终止妊娠时间选择对母婴预后的影响

目的 探讨选择不同时间终止妊娠对妊娠合并糖尿病产妇及胎婴预后的影响.方法 回顾性分析64例妊娠合并糖尿病患者的资料,按终止妊娠的孕周将患者分三组,A组25例为38周前终止妊娠;B组32例为38～＜40周终止妊娠;C组7例为40～42周终止妊娠.结果 （1）三组患者均有并发症发生,其中C组患者发生酮症酸中毒1例（14.3%）,胎儿窘迫4例（57.1%）,与A、B组比较,差异有统计学意义（P＜0.05）.（2）三组围生儿结局比较,A组死亡1例,死亡率为4.0%;C组胎儿生长受限、巨大儿、新生儿呼吸窘迫综合征发生率均最高,分别为14.3%（1/7）,71.4%（5/7）,14.3%（1/7）,与A、B组比较差异有统计学意义.（3）三组患者分娩方式比较,差异有统计学意义（P＜0.05）,三组患者剖宫产率均高于阴道分娩率,B组患者剖宫产率达87.5%.结论 妊娠合并糖尿病患者应根据病情轻重,发病孕周及胎儿宫内状况采取个体化的治疗方案,选择恰当的时机终止妊娠,能取得较好的母婴结局,保守治疗时应实施严密监护.

Influence of pregnancy termination time on maternal and perinatal prognosis of patients with gestational diabetes mellitus

Objective To investigate the influence of termination of pregnancy on maternal and perinatal prognosis of patients with gestational diabetes mellitus. Methods Retrospective analysis was conducted on data of 64 cases of pregnancy associated with diabetes, who were divided into three groups according to the time of pregnancy termination：group A was with preg- nancy termination before 38 weeks （n=25）, group B was with pregnancy termination during 38 weeks to 39 weeks （n=32） and group C was with pregnancy termination during 40 weeks to 42 weeks（n=7）. Results Complications occurred in all the three groups, and the patients in group C were with ketoacidosis in 1 case （14.3 % ） and fetal distress in 4 cases （57.1% ） ;comparing with the group A and group C, the difference had statistical significance （P〈0.05）. One case died in group A with the death rate of 4.0% ;the fetal growth restriction（FGR） ,fetal macrosomia and respiratory distress syndrome（RDS） in group C had high incidence rate ,which was 14.3% （ 1/7 ）, 71.4% （5/7） and 14.3% （ 1/7 ） respectively. Comparing with the group A and group B, the difference of group C had statistical significnace. The comparison of delivery way among the three groups had statistically significant difference （P〈0.05）, the cesarean section rate of the patients in the three groups was all higher than that of vaginal delivery and the cesarean section rate in group B arrived to 87.5%. Conclusion Individualized treatment should be adopted according to the disease condition of the pregnancy associated with diabetes, gestational weeks of onset and fetal condition in uterus. Pregnancy should be terminated in an optimal time ,which can obtain a better result for mother and fetus. The close monitoring should employed when conservative treatmefit is conducted.