产前预测巨大儿及经不同分娩方式对分娩结局的影响

Impact of prenatal prediction of macrosomia and different delivery mode on outcomes of delivery

关键词:  巨大儿  产前预测  分娩方式  妊娠结局

Key words:  fetal macrosomia  prenatal prediction  delivery methods  pregnancy outcome

摘要:

目的　 探讨巨大儿分娩前的预测及其分娩过程中及分娩后母婴并发症的处理措施，明确不同分娩方式对巨大儿分娩结局的影响。为指导临床预防巨大儿发生、降低母婴并发症及提高新生儿出生质量提供依据。　方法　对2011年1月至2013年12月于大连医科大学附属第一医院分娩的4562例新生儿中390例巨大儿的临床资料进行回顾性分析。对除外46例合并严重并发症的344例巨大儿，根据产前推算胎儿体重是否达到4000 g为标准进行分组，胎儿体重≥4000 g的作为预测组（149例），<4000 g的作为忽略组（195例）。对两组孕前情况、分娩方式、胎位异常、产程特点及母婴分娩结局等各项指标进行比较。　结果　预测组的患者孕前体重、孕期体增加、胎儿双项径、腹围、股骨长及彩超预测胎儿体重、新生儿出生体重、患者剖宫产率、阴道试产失败率均明显高于忽略组（P＜0.05）；而预测组产后出血、会阴裂伤、胎儿宫内窒息的发生率、新生儿低血糖率明显低于忽略组（P＜0.05）；390例巨大儿中，经阴道分娩组78例、阴道试产失败改行剖宫产组58例，直接行剖宫产组254例。3种分娩方式并发症总发生率分别为42.31%、10.34%、7.87%，组间比较均P＜0.05。　结论 　应重视并加强围产期管理、采取积极防治措施预防巨大儿的发生，产前明确诊断、选择合适的分娩方式，以利于减少剖宫产率及母儿并发症。

Abstract:

Objective To investigate prenatal prediction and delivery process of macrosomia, as well as treatment measures of complications in the mothers and children. So that we can predict fetal macrosomia, lower complications of the mothers and children, and improve quality of newborns. 　Methods We investigated the fetal macrosomia who were born in the First Affiliated Hospital of Dalian Medical University from January 1 in 2011 to December 31 in 2013, and made a retrospective analysis of them. Totally, 390 cases of macrosomia birth were included in the retrospective analysis among the 4562 newborns, except 46 macrosomia combined with severe diseases. According to the fetal weight, we divided them into two groups: the prediction group (fetal weight ≥4000 g, 106 cases) and the ignorance group (weight<4000 g, 178 cases). Prepregnancy conditions, mode of delivery, fetal abnormalities, maternal and child labor characteristics and birth outcomes were compared between the two groups. 　Results The prepregnancy weight, weight increment during pregnancy, biparietal diameter, abdomen circumference, femur length of the fetus, estimated fetal weight by color ultrasound, neonatal birth weight, and the rates of incisional delivery and failed vaginal trail delivery were higher in the prediction group than those in the ignorance group （P＜0.05). While the complications of postpartum hemorrhage, perineal laceration, fetal distress in uterus, neonatal hypoglycemia were lower in the prediction group than those in the ignorance group （P＜0.05). There were 78 cases of vaginal delivery, 58 cases of uterine-incision delivery after failed vaginal trial delivery, and 254 cases of direct uterine-incision delivery among the 390 cases of macrosomia. The total complications (42.31%, 10.34%, and 7.87%, respectively) were different among the three groups （P＜0.05). 　Conclusion It is important to strengthen perinatal management, take active preventive measures prevent the occurrence of macrosomia, make prenatal diagnosis, and choose appropriate delivery mode, in order to decrease uterine-incision delivery and the complications of the mothers and the children.