150例巨大胎儿产前诊断与分娩结局探讨

目的:了解≥4500 g的巨大胎儿产前诊断、分娩方式以及对母婴的影响。方法:回顾分析150例≥4500 g的巨大胎儿发生率以及特点、相关因素、产前预测方法比较、对母胎的影响及预后。结果:≥4500 g的巨大胎儿发生率0.68%,与经产、过期妊娠、孕妇身材较高、体重指数过重、产前充分休息、新生儿性别为男婴、不良孕产史、合并糖尿病等相关。产前体重预测准确率偏低。巨大胎儿对母儿易造成手术产率增加、产后出血、新生儿窒息、产伤甚至肩难产等。糖尿病性巨大胎儿较非糖尿病儿体重更重,差异有非常显著性(P<0.01)。新生儿中度、重度窒息以及产伤主要分布在阴道分娩组。结论:加强产前检查与干预,寻求预测巨大胎儿更加准确的方法,对巨大胎儿的诊治因人而异,选择最合适的分娩时机和方式。

Investigation on Antenatal Diagnosis and Pregnant Outcome of Fetal Macrosomia Weight over 4500 g:Analysis of 150 Cases

Objective: To understand the antenatal diagnosis and delivery mode in macrosomia fetal weight over 4500 g,and the influence on mother and child. Methods: 150 fetal macrosomia weighing over 4500 g were retrospectively reviewed about the prevalence,related characteristics,antenatal predictive factors,and prognosis. Results: The prevalence of macrosomic baby weight over 4500 g was 0.68%,and related factors included multiparity,prolonged pregnancy,higher body height of pregnant women,over BMI,sufficient rest,male fetus,abnormal history of pregnancy and labor,complicated with diabetes.The accurate prognosis for neonatal weight was low.The rate of CS,postpartum hemorrhage,neonatal asphyxia,birth injury,and shoulder dystocia increased in them.The fetal weight in pregnant women with chronic diabetes were higher than others( P <0.001).The distribution of moderate and severe asphyxia and birth injury mainly occurred in vaginal delivery. Conclusions: It's important to enhance antenatal interview and intervention,and to seek for a good way to accurate diagnosis of macrosomia.The treatment for macrosomia should base on individualized approach to choose suitable childbirth mode and opportunity.