初产妇与经产妇巨大儿分娩方式比较

The mode of delivery of macrosomia in primigravidae and multigravidae

目的 探讨产次对巨大儿分娩方式的影响。方法 对 2 0 0 0年 1月～ 2 0 0 3年 12月在我院分娩巨大儿的 131例正常单胎头位产妇进行回顾性分析 ,比较初产妇 (n =10 0 )与经产妇 (n =31)巨大儿的分娩方式及母儿并发症 ,并分别与同期分娩正常体重儿的初产妇和经产妇进行比较。结果 与分娩正常体重儿的产妇比较 ,分娩巨大儿的初产妇及经产妇选择性剖宫产率均明显增高 (2 2 0 %VS 38 0 % ,P <0 0 1;14 9%VS 32 3% ,P <0 0 5 ) ;初产妇试产失败急诊剖宫产率也明显增高 (18 0 %VS 4 1 9% ,P <0 0 1) ,产后出血率增加 (0 4 %VS3 0 % ,P <0 0 5 ) ;经产妇阴道分娩成功率及母儿并发症与分娩正常体重儿的产妇间差异无显著性 (P >0 0 5 )。结论 估计胎儿体重低于 4 5 0 0g的低危产妇可给予阴道试产机会 ,初产妇应特别注意产程观察及产后出血的防治。巨大儿实施选择性剖宫产应慎重。

Objective To analyze the effect of parity in the gravidae on the mode of delivery of macrosomia.Methods One hundred and thirty one uncomplicated,singleton,vaginal deliveries of baby weighted more than 4 kg from Jan.2000 to Dec.2003 were analyzed.Mode of delivery,maternal and neonatal complications were compared between primigravidae(n=100)and multigravidae(n=31).We also compared outcomes in primigravidae and multigravidae between macrosomia and normal weight babies respectively.Results Higher rates of cesarean section were observed in macrosomia than normal weight baby,both in primigravidae(38.0% vs.22.0%,P<0.01)and multigravidae(32.3% vs.14.9%,P<0.05).Higher incidence of emergent cesarean section(41.9% vs 18.0%,P<0.01)and postpartum hemorrhage(3.0% vs 0.4%,P<0.05)were observed in primigravidae than in multigravidae.The incidence of successful vaginal delivery and maternal and neonatal complications were similar between macrosomia babies and normal weight babies in multigravidae.Conclusions A trial of labor may be attempted in low risk gravidae with macrosomia less than 4 500 g weight.Accurate assessment of progress during labor and active prophylaxis against postpartum hemorrhage are crucial in primigravidae.Selective cesarean section should be chosen carefully.