终止妊娠时机对妊娠期糖尿病孕妇与围产儿结局的影响研究

Effect of Pregnancy Termination on Pregnant Women with Gestational Diabetes Mellitus and Perinatal Outcome

目的探讨终止妊娠时机对妊娠期糖尿病（GDM）孕妇与围产儿结局的影响。方法回顾性分析2013年6月—2016年6月在成都市第二人民医院妇产科就诊的179例GDM孕妇的临床资料。根据孕妇终止妊娠时机不同分为早期组67例（终止妊娠时间33-36＋6周）、中期组53例（终止妊娠时间37-39＋6周）、晚期组59例（终止妊娠时间40-41＋6周）。3组孕妇均给予定期门诊产前检查及常规护理,并给予胰岛素治疗、运动干预及饮食干预。比较3组孕妇及胎儿的并发生症发生率（孕妇产后出血、羊水过多、胎膜早破、妊高征及胎儿窒息、巨大儿、低血糖、死亡）。结果 3组孕妇产后出血、羊水过多、胎膜早破、妊高征比较,差异有统计学意义（P〈0.05）;中期组和晚期组孕妇产后出血、羊水过多、胎膜早破、妊高征发生率均低于早期组（P〈0.05）;中期组孕妇产后出血、羊水过多、胎膜早破、妊高征发生率均低于晚期组（P〈0.05）。3组胎儿窒息、巨大儿、低血糖、死亡发生率比较,差异有统计学意义（P〈0.05）;中期组和晚期组胎儿并发症发生率低于早期组（P〈0.05）;中期组胎儿窒息、巨大儿、低血糖、死亡发生率均低于晚期组（P〈0.05）。结论选择37-39＋6周终止妊娠的效果确切,可明显改善GDM孕妇的妊娠结局,减少母婴并发症的发生。

Objective To investigate the effect of pregnancy termination on pregnant women with gestational diabetes mellitus（ GDM） and perinatal outcome. Methods Retrospective analysis of clinical data of 179 pregnant women with GDM from June 2013 to June 2016 in obstetrics and gynecology of the Second People’ s Hospital of Chengdu City. According to the different pregnancy termination were divided into early group with 67 cases（ termination of pregnancy 33-36＋ 6weeks）,middle group with 53 cases（ termination of pregnancy 37-39＋ 6weeks）,advanced group with 59 cases（ termination of pregnancy time40-41＋ 6weeks） group. The three groups were all received regular outpatient antenatal examination, routine nursing care,insulin therapy, exercise intervention and dietary intervention. The complications incidence（ postpartum hemorrhage,polyhydramnios, membrane rupture and asphyxia, macrosomia, hypoglycemia, death） of pregnant women and fetus were compared. Results The incidence of postpartum hemorrhage, polyhydramnios, membrane rupture, pregnancy induced hypertension among the three groups showed significant differences（ P 〈 0. 05）; in middle group and advanced group incidence of postpartum hemorrhage, polyhydramnios, membrane rupture, pregnancy induced hypertension was lower than in the early group（ P 〈 0. 05）; in the middle group incidence of postpartum hemorrhage,polyhydramnios,membrane rupture,pregnancy induced hypertension was lower than in the late group（ P 〈 0. 05）. The fetal asphyxia,macrosomia,hypoglycemia,death rate among the three groups showed significant differences（ P 〈 0. 05）; in the middle group and advanced group fetal complication rate was lower than that of the early group（ P 〈 0. 05）; in the middle group fetal macrosomia,asphyxia,hypoglycemia,death rates were lower than in the late group（ P 〈 0. 05）. Conclusion The effect of pregnancy terminationfrom 37 to 39＋ 6weeks is accurate,which can significantly improve the pregnancy outcome of pregnant women and reduce the incidence of maternal and neonatal complications.