高龄初产妇不良妊娠结局及其相关危险因素分析

Analysis of adverse pregnancy outcome and related risk factors in elderly primipara

目的分析高龄初产妇不良妊娠结局及其相关危险因素。方法于2014年1月-2016年10月期间,选择在山东省无棣县水湾中心卫生院分娩的897例初产妇为研究对象,进行回顾分析,按照分娩年龄分为两组:高龄组(≥35岁)158例、适龄组(20~34岁)739例,比较两组产妇的不良妊娠结局情况,在此基础上将高龄组产妇分为不良妊娠结局组(39例)、正常分娩组(119例),并分析不良妊娠结局的危险因素。结果高龄组产妇产后出血、早产、新生儿畸形、新生儿窒息、低体重儿、巨大儿、先天疾病及不良妊娠结局总发生率均明显高于适龄组,差异有统计学意义(P<0.05)。不良妊娠结局组产妇流产史、妊娠期高血压、妊娠期糖尿病、前置胎盘、剖宫产、胎盘粘连/植入、心电图异常、凝血功能障碍百分比明显高于正常分娩组,差异有统计学意义(P<0.05)。经多因素回归分析证实流产史、妊娠期高血压、妊娠期糖尿病、前置胎盘、剖宫产、胎盘粘连/植入、心电图异常、凝血功能障碍是不良妊娠结局发生的独立危险因素(P<0.05)。结论高龄初产妇不良妊娠结局发生率明显高于适龄组,流产史、妊娠期高血压、妊娠期糖尿病、前置胎盘、剖宫产、胎盘粘连/植入、心电图异常、凝血功能障碍是不良妊娠结局发生的独立危险因素。

Objective To analyze the adverse pregnancy outcome and related risk factors of the elderly primipara. Methods In January,2014-October,2016,897 cases of primipara were selected in our hospital as the research subjects. The data of them were retrospectively analyzed. According to the age of childbirth were divided into two groups： the elderly group（over 35 years,158 cases）and normal age group（20-34 years old,739 cases）. The adverse pregnancy outcomes were compared between the two groups.According to the pregnancy outcomes,the old age group was further divided into adverse pregnancy outcome group（39 cases） and normal delivery group（119 cases）. The risk factors of adverse pregnancy outcomes were analyzed. Results The incidence of postpartum hemorrhage,premature delivery,neonatal malformation,neonatal asphyxia,low birth weight,fetal birth,congenital diseases and adverse pregnancy outcomes in elderly group were significantly higher than those in the normal age group（P 〈0. 05）. In the adverse pregnancy outcome group,the proportions of maternal history of abortion,gestational hypertension,gestational diabetes,placenta previa,cesarean section,placental adhesion/implantation,electrocardiogram abnormality and coagulation dysfunction were significantly higher than those of normal delivery group（P 〈0. 05）. Multivariate regression analysis showed that the history of abortion, gestational hypertension, gestational diabetes, placenta previa, cesarean section, placental adhesion/implantation,electrocardiogram abnormality and coagulation dysfunction were the independent risk factors for adverse pregnancy outcomes（P 〈0. 05）. Conclusion The incidence of adverse pregnancy outcomes of elderly primipara are significantly higher than those of normal group. Abortion,gestational hypertension,gestational diabetes,placenta previa,cesarean section,placenta accreta/implant,abnormal electrocardiogram,blood coagulation dysfunction are an independent risk factor for adverse pregnancy outcomes.