187例高龄产妇妊娠结局的临床分析

Clinical analysis of pregnancy outcome in older parturient women

目的近年来,高龄产妇比例逐渐上升,其妊娠结局也日益受到广泛关注。本文旨在探讨分析高龄产妇的临床结局以及对母儿的影响。方法采用回顾性研究的方法,于2011年1月—2014年1月收住慈溪市妇幼保健院的187例年龄大于或等于35岁的高龄产妇纳入研究作为观察组,同时选取同期年龄低于34岁的187例非高龄产妇作为对照组。比较2组产妇的并发症发生情况、新生儿出生情况以及分娩方式等。统计学分析采用t检验或χ2检验。结果观察组在妊娠期高血压、胎儿生长受限、早产和妊娠期糖尿病并发症的发生率高于对照组,差异有统计学意义(P<0.05);而在前置胎盘、新生儿窒息、巨大儿、胎儿畸形、胎儿窘迫、产后出血与胎膜早破并发症的发生率与对照组相比,差异无统计学意义(P>0.05);观察组高龄产妇剖宫产率为62.0%(n=116),明显高于观察组(n=70,37.4%),差异具有统计学意义(χ2=22.632,P<0.05);经阴道分娩时使用产钳进行助产的比例2组差异无统计学意义(P>0.05)。结论高龄产妇易患妊娠期并发症但对新生儿结局影响较小,多采用剖宫产方式进行生产。对于高龄产妇应加强围产期保健,积极预防和治疗妊娠并发症,同时加强孕期宣教并减少社会因素的影响,加强分娩监护及产程管理并慎重选择分娩方式。

Objective In recent years, the proportion of elderly parturient women gradually rise, the pregnancy outcome attaches more and more attentions. The aim of this paper is to discuss the effects of advanced maternal age and the mater- nal and fetal outcomes. Methods 187 elderly parturient women aged 35 and over（observation group） and 187 young parturient women aged 35 and over（ control group） in our hospital from January 2011 and January 2014 were enrolled in this study, and the clinical data were analyzed retrospectively. The incidence of complications, newborn situation and deliv- ery way between the two groups were compared. The t-test and chi-square test were used for the statistical analysis. Re- suits The incidence of complications such as gestational hypertension,intrauterine growth restriction,premature delivery and gestational diabetes mellitus in the observation group was significantly higher than that in the control group （P 〈 0.05 ）. The difference in placenta previa, neonatal asphyxia, fetal macrosomia, fetal malformation, fetal distress, postpartum hemorrhage and premature rupture of membranes was not significant between the two groups （P 〉 0.05）. The rate of cesar- ean section in the observation group（62.0% ） was significantly higher than 37.4% in the control group（x^2 =22.632, P 〈 0.05 ）. The proportion of using forceps in the cases with vaginal delivery was no significant difference between the two groups （P 〉 0.05）. Conclusion The elderly parturient women are usually with a high rate of pregnancy complications, but the influence of complications on the fetal outcomes is mild, and caesarean section is the common way of delivery. For the elderly parturient women, it is necessary to strengthen perinatal health care, prevent and treat the pregnancy complica- tions, strengthen education during pregnancy and reduce the influence of social factors, strengthen labor monitoring and la- bor management and choose carefully the way of childbirth.