晚期早产儿与早期足月儿剖宫产分娩高危因素及预后分析

Analysis on high- risk factors and prognosis of cesarean section in late preterm infants and early full- term infants

目的探讨晚期早产儿与早期足月儿剖宫产分娩高危因素的差异及其对新生儿并发症的影响,为合理降低剖宫产率及改善新生儿预后提供理论依据。方法选取2013年1-12月在该院出生的胎龄为34^(+0)~38^(+6)周活产新生儿及其母亲的临床资料,依据胎龄分为晚期早产儿(胎龄为34^(+0)~36^(+6)周)873例(LP组)和早期足月儿(胎龄为37^(+0)~38^(+6)周)2 033例(ET组)。分析比较两组新生儿剖宫产分娩高危因素及其对新生儿预后影响的差异。结果 1孕产妇情况:晚期早产儿剖宫产比例高于早期足月儿(P<0.05)。二元Logistic回归分析显示,晚期早产儿母亲剖宫产分娩的高危因素为妊娠期高血压疾病、瘢痕子宫、多胎、胎盘异常、胎位异常、羊水异常等;早期足月儿母亲剖宫产分娩的高危因素为瘢痕子宫、胎位异常、多胎。2新生儿情况:晚期早产儿中,剖宫产分娩者高胆红素血症、新生儿呼吸窘迫综合征(RDS)及住院天数均明显高于阴道分娩者(P<0.05);早期足月儿中,剖宫产分娩者转入新生儿病房、黄疸、RDS、感染性疾病及窒息比例均高于阴道分娩者(P<0.05)。结论导致晚期早产儿与早期足月儿母亲剖宫产分娩的高危因素存在差异,剖宫产可导致新生儿期多种疾病的发病率及新生儿病房入住率的增加,应依据胎龄采取相应的措施减少或避免剖宫产的发生。

Objective To explore the differences of high risk factors of cesarean section between late preterm infants and early full- term infants and the impact on neonatal complications,provide a theoretical basis for reasonably reducing cesarean section rate and improving neonatal prognosis. Methods The clinical data of alive neonates（ fetal age： 34^（＋ 0）- 38^（＋ 6）weeks） born in the hospital from January to December in 2013 and their mothers were selected,then the cases were divided into late preterm infant group（ 873 cases,fetal age： 34^（＋ 0）- 36^（＋ 6）weeks） and early full- term infant group（ 2 033 cases,fetal age： 37^（＋ 0）- 38~ （＋ 6）weeks）. The high- risk factors of cesarean section and the difference of effects on neonatal prognosis in the two groups were analyzed and compared. Results The rate of cesarean section in late preterm infant group was statistically significantly higher than that in early full- term infant group（ P〈0. 05）. Binary logistic regression analysis showed that the high- risk factors of cesarean section in late preterm infant group included hypertensive disorder complicating pregnancy,scarred uterus,multiple pregnancy,placental abnormalities,abnormal fetal position,and amniotic fluid abnormality; the high-risk factors of cesarean section in early full- term infant group included scarred uterus,abnormal fatal position,and multiple pregnancy. Among the cases born by cesarean section,870 cases were transferred to neonatal wards（ 38. 5%）,which was statistically significantly higher than the proportion of cases born by vaginal delivery（ P〈0. 05）. In late preterm infant group,the incidence rates of hyperbilirubinemia and neonatal respiratory distress syndrome（ RDS） among the cases born by cesarean section were 68. 5% and 18. 4%,respectively,which were statistically significantly higher than those among the cases born by vaginal delivery（ P〈0. 05）. In early full- term infant group,the proportion of cases transferred to neonatal wards born by cesarean section was 18. 0%,which was statistically significantly higher than that among the cases born by vaginal delivery（ 9. 5%）（ P〈0. 05）; the incidence rate of RDS was 1. 4%,which increased significantly（ P〈0. 05）. In late preterm infant group,the incidence rates of hyperbilirubinemia and RDS,and the hospitalization time among the cases born by cesarean section were statistically significantly higher than those among the cases born by vaginal delivery（ P〈0. 05）. In early full-term infant group,the proportion of cases transferred to neonatal wards,the incidence rates of jaundice,RDS,infectious diseases,and asphyxia among the cases born by cesarean section were statistically significantly higher than those among the cases born by vaginal delivery（ P〈0. 05）. Conclusion There are significant differences in the high- risk factors between late preterm infants and early full- term infants,cesarean section can increase the incidence rates of multiple neonatal diseases and the transfer rate to neonatal wards,corresponding measures should be taken according to fetal age to reduce or avoid cesarean section.