原因不明胎儿生长受限分娩方式探讨

Exploring the appropriate delivery way in unexplained fetal growth restriction

目的探讨原因不明胎儿生长受限(fetal growth restriction,FGR)的适宜分娩方式。方法收集2002年10月至2007年10月在延边大学附属医院出生的单胎足月原因不明FGR新生儿65例,分为3组;阴道分娩组(25例)、选择性剖宫产组(18例)和急症剖宫产组(22例),分析不同分娩方式新生儿的出生体重、1min和5min的Apgar评分、新生儿气管插管率、儿科住院率以及胎粪污染率。结果阴道分娩组、选择性剖宫产组和急症剖宫产组新生儿平均出生体重分别为(2.30±0.15)kg、(2.20±0.29)kg、(2.08±0.14)kg(P<0.05);1min平均Apgar评分值分别为7.51±1.71、7.06±1.26、6.05±1.56(P<0.05);5min平均Apgar评分值分别为8.88±1.24, 8.67±0.84,7.77±1.31(P<0.05);急症剖宫产组新生儿气管插管率(27.3%)和胎粪污染率(31.8%)最高,阴道分娩组入儿科住院率最高(68.0%)。结论对原因不明的FGR采用剖宫产术分娩是最适宜的分娩方式,可减少胎儿窘迫和新生儿窒息,并降低FGR围生儿的患病率。

Objective To explor the appropriate delivery way in unexplained fetal growth restriction （FGR）. Methods A total of 65 neonates（ all of monoeyesis and term） with FGR were collected from the Affiliated Hospital of Yanhian University. All eases were divided into three groups： vagina delivery group（ n =25 ） , selected cesarean delivery group（ n = 18 ）and urgent cesarean delivery group （n = 22 ）. The following parameters were determined and compared in the three groups ; the birth weight, 1 and 5 minute＇ s Apgar score, the rates of endotrachel intubation, hospitalization of the pediat- rics and meeonium-stained amniotie fluid. Results In three groups,the average weight of newborns was（ 2. 30 ±0. 15） kg,（2. 20 ±0. 29）kg and （2.08 ±0. 14）kg（ P 〈0. 05） ; the 1 minute＇ s Apgar score was 7. 51 ± 1.71,7.06 ± 1.26 and 6.05 ± 1.56 （P 〈0. 05） ; and the 5minute＇ s Apgar score was 8. 88 ± 1.24, 8. 67 ±0. 84 and 7. 77 ± 1.31 （P 〈 0. 05 ）, respectively. The rates of endotraehel intubation （ 27.3% ） and meeonium-stained amniotie fluid （ 31.8% ） was highest in the urgent cesarean delivery group, and the hospitalization of the pediatrics was highest（68. 0% ）in the vagina delivery group. Conclusion The cesarean section was the most appropriate way of delivery to the unexplained FGR, and this way can decreases fetal distress, asphyxia neonatorum, and reduces perinatal morbidity.