极早期和早期早产并发症及早产儿结局分析

Analysis on Complications and Premature Infant outcomes of Extremely and Early Preterm Birth

目的:分析极早期和早期早产间妊娠并发症、分娩方式及早产儿出生结局的差异。方法:随机选择2015年3月至2017年2月在南京医科大学附属妇产医院孕32周之前分娩的166例孕妇为研究对象,按分娩孕周分为极早期早产组(<孕28周,64例)和早期早产组(孕28~31+6周,102例),对两组孕产妇及早产儿相关临床资料进行回顾性分析。结果:(1)两组孕妇的妊娠并发症主要包括:胎膜早破(27.11%)、妊娠期糖尿病(22.89%)、胎位异常(17.47%)、胎盘异常(16.27%)、宫颈机能不全(6.02%)及胎儿窘迫(5.42%);但是早期早产组并发妊娠期糖尿病的发生率明显高于极早期早产组(P<0.05),而宫颈机能不全的发生率明显低于极早期早产组(P<0.05)。(2)早期早产组的剖宫产率明显高于极早期早产组(P<0.001),其中早期早产组中以并发胎盘异常的孕妇剖宫产率明显增加(P<0.05)。(3)早期早产组新生儿出生状况优于极早期早产组新生儿(P<0.001),而极早期早产组新生儿NICU住院天数、治疗放弃率长于或高于早期早产组新生儿(P<0.001)。结论:孕期应重视常见妊娠并发症胎膜早破的发生,积极筛查妊娠期糖尿病及识别宫颈机能不全的高危因素。对于医源性的早产,应慎重权衡利弊,在母儿安全的前提下,尽量延长孕周至孕28周以上,以改善早产儿结局。

Objective： To analyze the difference of pregnancy complications,modes of delivery,preterm infant outcomes between extremely and early preterm birth.Methods： 166 pregnant women were divided into two groups according to gestational age of delivery.64 cases were extremely preterm group and 102 cases were early premature group.The clinical data of pregnant women with extremely and early preterm birth were retrospectively analyzed.Results：（1）The related pregnancy complications of extremely and early preterm birth were as follows： premature rupture of membranes（ PROM）（ 27. 11%）,gestational diabetes mellitus（ 22. 89%）,abnormal fetal position（ 17. 47%）,placenta abnormality（ 16. 27%）,cervical incompetence（ 6. 02%） and fetal distress（ 5. 42%）.However,incidence of early preterm birth with gestational diabetes was significantly higher than that of extremely preterm delivery（ P〈0. 05）,while incidence of congenital cervical incompetence of early preterm birth was significantly lower than that of extremely preterm delivery（ P〈0. 05）.（2）Cesarean section rate in early preterm birth group was higher than that in extremely preterm birth group（ P〈0. 001）.In the early preterm group,cesarean section rate was significantly higher in women with multiple births and abnormal placenta（ P〈0. 05）.（3）Outcomes of infants in early premature group were better than those in extremely premature group（ P〈0. 001）.The incidence of ICU stay and rate of abandonment of treatment in early premature group were higher than those in extremely premature group（ P〈0. 001）. Conclusions： We should pay attention to the high risk factors of PROM during pregnancy,screen gestational diabetes in time,and identify high-risk factors of cervical incompetence.For iatrogenic preterm birth,the pros and cons should be carefully weighed.Under the premise of maternal and child safety,gestational age should be extended to more than 28 gestational weeks to improve the outcome of premature infants.