巨大儿的影响因素及其产前预测

Influencing Factors of the Fetal Macrsomia and Antepartum Prediction

目的探讨巨大儿的影响因素,为临床产前预测巨大儿及选择恰当的分娩方式提供理论依据。方法选择2012年1月至12月于广东省佛山市妇幼保健院产科住院分娩的10 174例产妇中的429例分娩巨大儿（出生体质量≥4 000g）产妇的临床资料为研究对象,并纳入观察组（n=429）;选择同期于本院住院分娩的429例分娩正常足月儿（出生体质量为2 500-4 000g）产妇的临床资料纳入对照组（n=429）。本研究遵循的程序符合广东省佛山市妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书。分析2007-2012年本院巨大儿发生率变化情况。比较两组产妇基本情况（年龄、身高、产次）、分娩前情况（分娩前末次宫高、腹围、妊娠图曲线异常）、体质量变化情况（孕龄为20孕周时体质量、孕期增重、分娩时体质量）、胎儿情况（胎儿双顶径、股骨长）、妊娠期并发症发生情况[是否合并羊水量过多、妊娠期糖尿病（GDM）等]及分娩情况（分娩孕龄、分娩方式、新生儿Apgar评分结果异常）等因素。结果广东省佛山市妇幼保健院2007-2012年巨大儿发生率呈逐年递增趋势。观察组产妇年龄、身高、分娩孕龄、产次、孕龄为20孕周时体质量、分娩时体质量、孕期增重、宫高、腹围、妊娠图异常曲线、胎儿双顶径、股骨长及合并羊水量过多和及GDM发生率均显著高于对照组,两组比较,差异有统计学意义（P〈0.05）。观察组产妇所分娩男性新生儿发生巨大儿的风险是女性的1.84倍。观察组剖宫产率为69.5%,显著高于对照组（30.8%）,两组比较,差异亦有统计学意义（P〈0.05）。结论产妇年龄、身高、体质量、分娩孕龄、产次、宫高、腹围、合并羊水量过多或（和）GDM是产前诊断巨大儿的影响因素。重视妊娠图曲线变化,结合超声检查对产前预测巨大儿及选择合适的分娩方式有重要参考价值。

Objective To analyze influencing factors of fetal macrosomia in order to predict fetal macrosomia and select the appropriate mode of delivery. Methods From January to December 2012,a total of 429 cases of fetal macrosomia（birth weight≥4 000g ） were analyzed retrospectively as research group （n=429）. Meanwhile 429 cases normal newborn（birth weight 2 500g-4 000g ） delivered in the same time were selected as control group（n=429）. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Hospital of Maternity and Children of Foshan. Informed consent was obtained from each participants. Clinical data of maternal age, height, gestational weeks at delivery, parity, maternal body weight in the 20th gestational week and before delivering, height of uterus, maternal abdominal circle, biparietal diameter （BPD）, femur length （FL）, gender of fetus, whether combined with hydramnion and gestational diabetes mellitus（GDM） or not, and delivery pattern were compared between two groups. Results There were significant differences between two groups in macrosomia, maternal age, height, gestational weeks at delivery, parity, maternal body weight in the 20th week pregnancy and before delivering, weight gain during pregnancy, height of uterus, maternal abdominal circle, BPD and FI.（P〈 0.05）. The incidence rate of male fetal macrosomia was 1.84 times as much as female in research group. The incidence rates of hydramnion and GDM were obviously higher than those of control group （P 〈 0. 05）. There was significant difference in cesarean section rate between two groups （P 〈 0. 05 ）. Conclusions Maternal age,height, weight, gestational weeks at delivery, parity,height of uterus, maternal abdominal circle, combined with hydramnion or GDM are influencing factors of fetal macrosomia. Gravidogram and ultrasound may contribute to prenatal diagnosis of fetal macrosomia.