高龄初产妇442例妊娠及分娩的临床分析

Clinical analysis of 442 cases of elderly primipara

目的 探讨高龄初产对妊娠及分娩发生合并症和并发症及分娩方式的影响。方法 选取在北京地坛医院2009年6月至2010年9月分娩的高龄初产妇（≥35岁）442例为观察组进行临床分析研究妊娠合并症和妊娠并发症的发生、分娩方式及妊娠结局，随机选取同期非高龄初产妇（＜35岁）450例为对照组，并进行统计学分析。结果 观察组妊娠合并子痫前期、子宫肌瘤、羊水少、巨大儿、臀位、糖尿病和糖耐量受损的比例显著高于对照组（χ^2分别为7．470、35．212、8．811、10．874、4．747、12．844、26．159，均P＜0．05）；对照组合并胎儿窘迫、胎膜早破的发生率显著高于观察组（χ^2分别为4．874、6．689，均P＜0．05）。高龄初产妇的剖宫产率为68．3％，明显高于对照组的33．6％。结论 高龄初产妇妊娠合并症和并发症的发生明显高于年轻初产妇，应避免高龄妊娠；对高龄妊娠应加强围产期保健，预防妊娠并发症，合理控制剖宫产手术指征，确保母婴安全与健康。

Objective To investigate the influence of elderly primipara on pregnancy outcomes and delivery mode .Methods From June 2009 to September 2010 442 cases of elderly primiparas （≥35 years old ） were selected from Beijing Ditan Hospital in experimental group to analyze the incidence of pregnant complications , delivery mode and pregnant outcomes .At the same period 450 normal primiparas were randomly selected in control group to conduct statistical analysis .Results The proportion of cases complicated with preeclampsia , uterine fibroids, oligohydramnios, fetal macrosomia, breech presentation, gestational diabetes, or impaired glucose tolerance was significantly higher in the experimental group than in the control group （χ^2value was 7.470, 35.212, 8.811, 10.874, 4.747, 12.844 and 26.159, respectively, all P〈0.05）.In the control group the incidence of fetus distress and premature rupture of membrane was significantly higher （χ^2value was 4.874 and 6.689, respectively, both P〈0.05）.The cesarean section rate of elderly primiparas （68.3%） was remarkably higher than that of the normal primiparas （33.6%）.Conclusion The incidence of pregnant complications among elderly primiparas is obviously higher than that among young primiparas , so elderly pregnancy should be avoided .For elderly pregnancy perinatal care should be strengthened , pregnancy complications should be prevented and the indications of cesarean section should be controlled reasonably to ensure maternal and fetal safety and health .