中国南北方地区阴道试产孕妇不良母婴结局分析

Adverse outcomes in pregnant women with trial of vaginal delivery:a comparison of southern and northern China

目的探讨我国南北方地区阴道试产孕妇不良母婴结局的差异,为不同地区制定适宜的孕产期保健管理措施提供依据。方法回顾性分析2016年3月—2016年8月,南北方地区20家医院(南方9家、北方11家)产检并住院阴道试产的7741名产妇的临床资料,其中南方4143例,北方3598人,采用1∶1倾向性评分匹配法进行匹配,多因素Logistic回归分析比较南北方地区阴道试产孕妇不良母婴结局的差异。结果南北方地区产妇的基线组间均衡性较好(P>0.05)。与北方地区相比,南方产妇患妊娠期高血压疾病(OR:0.42,95%CI:0.27~0.66,P=0.0002)、妊娠期高血压(OR=0.46,95%CI:0.28~0.77,P=0.0031)、先兆子痫(OR=0.26,95%CI:0.10~0.70,P=0.0077)、妊娠合并贫血(OR=0.29,95%CI:0.23~0.36,P<0.0001)、产程延长需剖宫产(OR=0.07,95%CI:0.01~0.53,P=0.0105)、产后感染(OR=0.11,95%CI:0.04~0.38,P=0.0004)的风险较低;南方发生妊娠合并甲状腺功能亢进(OR=3.22,95%CI:1.18~8.81,P=0.0226)、头盆不称需剖宫产(OR=3.01,95%CI:1.46~6.23,P=0.0029)的风险更高;南北方产妇患妊娠期糖尿病、妊娠合并甲状腺功能减退、产后出血和产后输血差异无统计学意义(P均>0.05)。与北方地区相比,南方新生儿大于胎龄儿(OR=0.60,95%CI:0.45~0.81,P=0.0006)比例降低;而静滴抗生素(OR=3.00,95%CI:1.03~8.72,P=0.0436)和转入NICU/新生儿高危病房(OR=7.05,95%CI:2.94~8.92,P<0.0001)的风险显著上升。结论我国南北方地区阴道试产孕妇部分不良母婴结局存在差异,应有针对性地加强地区孕产期保健管理。

Objective To compare pregnant outcomes of pregnant women with trial of vaginal delivery between northern and southern China.Methods A total of 7 741 pregnant women with trial of vaginal delivery,including 4 143 from 9 hospitals in southern China and 3 598 from 11 hospitals in northern China,were recruited from March 2016 to August 2016.The 1 ∶ 1 propensity score matching analysis (PSM) was used to match pregnant women between the northern and southern China.Multivariate Logistic regression analysis was used to compare the differences of pregnancy outcomes among pregnant women with trial of vaginal delivery between the northern and southern China.Results The baselines of pregnancy women in northern and southern China were matched well by PSM ( P >0.05).Pregnant women in southern China were at lower risk of developing hypertensive disorder complicating pregnancy (OR:0.42,95%CI:0.27-0.66,P =0.000 2),pre-eclampsia (OR=0.26,95%CI:0.10-0.70,P =0.007 7),gestational hypertension (OR=0.46,95%CI:0.28-0.77,P =0.003 1),anemia during pregnancy (OR=0.29,95%CI:0.23-0.36,P <0.000 1),caesarean section (CS) for prolonged labor (OR=0.07,95%CI:0.01-0.53,P =0.010 5),and postpartum infection (OR=0.11,95%CI:0.04-0.38,P =0.000 4).However,the risk of hyperthyroidism (OR=3.22,95%CI:1.18-8.81,P =0.022 6) and CS for cephalopelvic disproportion (OR=3.01,95%CI:1.46-6.23,P =0.002 9) was higher than pregnant women in southern China.There were no significant differences in gestational diabetes mellitus,hypothyroidism,postpartum hemorrhage,and postpartum transfusion between pregnant women in southern and northern China (all P >0.05).Compared to neonates in northern China,neonates in southern China had a lower proportion of large for gestational age (OR=0.60,95%CI:0.45-0.81,P =0.000 6);whereas,the risk of requiring intravenous drip of antibiotics (OR=3.00,95%CI:1.03-8.72,P =0.043 6) and admission to the NICU (OR=7.05,95%CI:2.94-8.92,P <0.000 1) increased significantly.Conclusion Some adverse pregnant outcomes of maternal and neonatal are significantly different between the pregnant women in southern and northern China.