非糖尿病性巨大胎儿368例临床分析

Clinical analysis of non-diabetic fetal macrosomia 368 cases

目的分析非糖尿病性巨大胎儿的相关危险因素,为临床预测巨大胎儿及选择恰当的分娩方式提供依据。方法回顾性分析南京军区南京总医院2006年1月至2007年12月期间出生的368例非糖尿病性巨大胎儿的临床资料,分析孕母的年龄、身高、基础体重、孕周、孕产次、分娩时体重、孕期增重、宫高、腹围及胎儿的股骨长、双顶径、分娩方式等,并与新生儿出生体重进行相关及回归分析。结果非糖尿病性巨大胎儿的发生率为13.23%(368/2781)。基础体重、分娩时体重、孕期增重、宫高、腹围、双顶径、股骨长、宫高+腹围、双顶径+股骨长是产前诊断非糖尿病性巨大胎儿的相关因素,而宫高及双顶径+股骨长相关性最为显著。非糖尿病性巨大胎儿与正常体重儿分娩方式差异无统计学意义。结论结合宫高及双顶径+股骨长能够提高非糖尿病性巨大胎儿的产前预测率。巨大胎儿并不是剖宫产的绝对指征。

Objective To analyze risk factors for non-diabetic fetal macrosomia to predict fetal macrosomia and select the appropriate mode of delivery. Methods Retrospective analysis was used with 368 cases of non-diabetic fetal macrosomia in Nanjing General Hospital of Nanjing Military Command between January 2006 and December 2007 and clinical data on maternal age, height, prepregnancy weight, gestational age, birth weight, gestational weight gain, height of uterus, abdominal circumference, femur length （FL）, biparietal diameter（BPD）. Statistical analysis used the chi-squared test, correlation, regression analysis, and as appropriate. P≤0.05 was considered significant. Results The incidence rate of non-diabetic fetal macrosomia was 13. 23% （368/2781）. Prepregnancy weight, birth weight, gestational weight gain, height of uterus, abdominal circumference, BPD, FL, uterus height plus abdominal circumference, BPD ＋ FL were correlated with fetal macrosomia, but the most significant correlation was height of uterus and BPD ＋ FL. There was no significant difference in delivery mode, compared maerosomia with normal birth weight infants. Conclusion The combination of BPD ＋ FL can improve prediction of fetal macrosomia. Fetal maerosomia is not an absolute indication of cesarean section.