高龄产妇不良妊娠结局相关高危因素的临床研究

Clinical research of related high risk factor of adverse outcome in advanced maternal

目的 探讨导致高龄产妇不良妊娠结局发生的高危因素。方法 回顾性分析2012年5月~2016年5月在我院分娩的925例≥35岁高龄产妇,并随机选择同期住院分娩的年龄介于20~34岁的适龄产妇925例作为对照。对比分析高龄产妇组与适龄产妇组在妊娠合并症及并发症、围生儿结局的差异,同时对影响高龄产妇分娩的危险因素进行多因素Logistic回归分析。结果 高龄产妇贫血、子宫肌瘤、妊娠合并糖尿病、妊娠期高血压疾病、前置胎盘及产后出血的发生率高于适龄产妇（P〈0.01）。高龄产妇新生儿窒息、巨大儿发生率及平均出生体重均高于适龄产妇（P〈0.05）,两组新生儿死亡、新生儿畸形发生率的比较差异无统计学意义（P〉0.05）。影响高龄产妇不良分娩结局的高危因素有多胎妊娠（P〈0.05）、前置胎盘（P〈0.01）、胎儿窘迫（P〈0.01）、贫血（P〈0.05）及异常心电图（P〈0.05）。结论 多胎妊娠、前置胎盘、胎儿窘迫、贫血及异常心电图是导致高龄产妇不良妊娠结局的高危因素,临床上应加强高龄孕产妇在妊娠期的保健,发现异常及时就诊,以减少不良妊娠结局的发生,达到母婴健康的目的。

Objective To explore the high risk factor that leading to adverse outcome in advanced maternal.Methods 925 elderly parturient women,aged more than 35 years old,who been confined from May 2012 to May 2016 of our hospital were retrospective analyzed,and 925 maternal age,aged 20-34 years old,who been confined at the same term were random selected as control.Pregnancy complications and complications,difference of perinatal outcome between elderly parturient women group and maternal age group were compared and analyzed.At the same time,multi factor Logistic regression analysis was used to analyze the risk factors that impacted advanced maternal delivery.Results The incidence rate of anemia,myoma of uterus,pregnancy associated with diabetes,hypertensive disorder complicating pregnancy,pla- centa previa and postpartum hemorrhage in advanced maternal were higher than maternal age （P〈0.01）.All of asphyxia of newborn,the incidence rate of great children and average birth weight in advanced maternal were higher than maternal age （P〈0.05）.The difference of newborn mortality and neonatal malformation rate between two groups had no statistical significance （P〉0.05）.The high risk factor that impacted adverse outcome in advanced maternal were multiple pregnancy （P〈0.05）,placenta previa （P〈0.01）,fetal distress （P〈0.01）,anemia （P〈0.05） and abnormal electrocardiogram （P〈0.05）.Conclusion Multiple pregnancy,placenta previa,fetal distress,anemia and abnormal electrocardiogram are high risk factor that resulting to adverse outcome in advanced maternal.In clinic,it should be strengthen the health care of the elderly pregnant women during pregnancy,timely treatment when finds abnormal to reduce the occurrence of adverse pregnancy outcome and to achieve the purpose of maternal and child health.