143例巨大儿临床分析

Clinical analysis on 143 cases of giant baby

目的:探讨巨大儿产科处理的合理性。方法:回顾分析143例巨大儿的分娩方式及结局。结果:143例巨大儿体重≥4 000 g,其中剖宫产117例,剖宫产率82%(117/143);产前诊断巨大儿48例,阴道分娩26例(18%);产后出血率:巨大儿剖宫产19%,阴道分娩19%;羊水粪染:剖宫产26%,阴道分娩38%;阴道分娩肩难产4例;软产道裂伤:剖宫产2例(1%),阴道分娩1例(7%)。结论:巨大儿不能作为剖宫产指征,但也不能盲目阴道试产,应根据不同情况选择不同的分娩方式。多因素评估胎儿体重,密切产程观察,正确把握试产时机,做好肩难产的预防和处理才能减少母婴损伤。

Objective To explore the reasonability of treatment of giant baby.Method To review and analyze 143 cases of giant baby′s delivery mode and results in writer′s hospital during May 2010 to June 2011.Results All the 143 giant babies have weight of 4 000 g or above,among which 117 delivered by caesarean,covering 82% of the whole（117/143）.Forty-eight cases were detected through prenatal diagnosis.Twenty-six giant babies were delivered by vaginal delivery,occupying 18% of the 143 cases.In terms of postpartum hemorrhage ratio,caesarean occupied 19% while vaginal delivery equaled the share.As for the meconium-stained amniotic fluid,caesarean occupied 26% while vaginal delivery covered 38%.Four cases were shoulder dystocia in vaginal delivery.Soft issue injury of the birth cannel happened twice in caesarean and once in vaginal delivery,covering 1% and 7%,respectively.Conclusion In the treatment of pregnant women,neither caesarean nor vaginal trial delivery could be applied as usual,instead,different delivery methods should be carried out according to different situations.In order to reduce fetomaternal injury,multiple measures should be taken into consideration：assessment of fetus′ weight from multi-factors,closely attention to delivery observation,correctly handling opportunity of giving birth on trial,and prevention and treatment of shoulder dystocia.