经产孕妇超重和肥胖对阴道分娩的影响

Infuence of Maternal Over Weight and Obesity on Vaginal Delivery

目的探查经产孕妇超重和肥胖对阴道分娩的影响。方法 2010年1月至2013年10月在我院入院住院并进行阴道试产的经产妇共576例,其中早孕期超重和肥胖即体重指数BMI为25～29.9的孕妇有184例,分娩时超重和肥胖BMI≥30有152例,观察超重和肥胖与分娩结局的影响。结果早孕期超重和肥胖经产妇平均总产程时间为（14.7±2.6）h,宫口扩张速度（0.68±0.14）cm/h;产程异常发生率、剖宫产率、巨大儿、新生儿窒息发生率分别为31.5%,35.9%,19.6%和6.0%,与对照组相比,差异有极显著性或显著性（P〈0.01,P〈0.05）。产前超重和肥胖经产妇平均总产程时间为（15.3±2.1）h,宫口扩张速度（0.79±0.12）cm/h;产程异常发生率、剖宫产率、巨大儿、新生儿窒息发生率分别为28.9%,38.8%,25.0%和6.6%,与对照组相比,差异有极显著性或显著性（P〈0.01,P〈0.05）。早孕期超重和肥胖经产妇孕期体重增加≥20 kg者,产程时长为（15.3±2.1）h,而体重增加〈20 kg者总产程时长为（14.2±2.4）h,与对照组相比,差异有显著性（P〈0.05）;孕妇体重增加≥20 kg者产程异常发生率、剖宫产率、巨大儿的发生率分别为46.9%,53.1%和29.7%,与体重增加〈20 kg的经产妇相比,差异有极显著性或显著性（P〈0.01,P〈0.05）。结论孕期超重和肥胖导致宫口扩张减缓、产程异常和手术产率增加。

Objective To investigate the influence of pluripara＇s overweight and obesity on vaginal delivered.Methods We studied576 pluripara women who delivered between Jan2010 to Oct 2013 in our hospital.Maternal obesity defined by BMI≥25 and BMI≤29.9in early pregnancy and BMI≥30 before delivery was 184 cases and 152 cases.The association of maternal overweight and obesity and vaginal delivery was observed.Results The mean duration of labor and cervical dilation rate for obese women in early pregnancy was（14.7±2.6）hours and（0.68±0.14）cm/h.The incidences of abnormal labor,cesarean section,macrosomia and birth asphyxia were 31.5%,35.9%,19.6%and 6.0%respectively.The differences between obese and normal pregnant women were very significant and significant（P〈0.01,P〈0.05）.The mean duration of labor and cervical dilation rate for obese women before delivery was（15.3±2.1）hours and（0.79±0.12）cm/h.The incidences of abnormal labor,cesarean section,macrosomia,and birth asphyxia were 28.9%,38.8%,25.0%and 6.6%respectively.The differences between obese and normal pregnant women were very significant and significant（P〈0.01,P〈0.05）.The obese women who gained weight above 20 kg in early pregnancy had a labor duration of（15.3±2.1）hours,compared with those who gained weight below20 kg had a labor duration of（14.2±2.4）hours.The differences between obese and normal pregnant women were significant（P〈0.05）.The incidences of abnormal labor,cesarean section,macrosomia were 46.9%,53.1%and 29.7%respectively in obese women who gained weight above 20 kg were significantly higher than those in obese women who gained weight below20 kg.The differences between obese and normal pregnant women were very significant and significant（P〈0.01,P〈0.05）.Conclusions Overweight and obese women were at higher risk of increased rate of cervical dilation,abnormal stage of labor and increased cesarean delivery.