初产妇分娩过程中紧急剖宫产风险与孕前BMI、孕期体重增加水平的关系

Relationship between Risk of Emergency Cesarean Section and BMI before Pregnancy and Weight Gain During Pregnancy in Primipara

目的:探讨初产妇分娩过程中紧急剖宫产风险与孕前体质量指数(BMI)、孕期体重增加水平的关系。方法:收集在本院试产的足月、头先露、单胎孕妇1 727例。根据分娩方式分为观察组(阴道分娩过程中行紧急剖宫产术)123例,对照组(阴道分娩)1 604例。根据孕前BMI分为低体重组301例、正常体重组1 260例、超重/肥胖组166例。根据妊娠期体重增加水平分为体重增加不足组289例,体重合理增加组745例,体重增加过多组693例。分析不同孕前BMI及妊娠期体重增加水平孕妇的阴道分娩过程中紧急剖宫产风险。结果:观察组新生儿出生体重明显高于对照组,大于胎龄儿比例明显高于对照组,差异有统计学意义(P<0.01)。随着孕前BMI增加,阴道分娩过程中紧急剖宫产率明显提升;与正常体重组相比,超重/肥胖组紧急剖宫产风险增高,低体重组紧急剖宫产风险降低。随着妊娠期体重增加量的增加,阴道分娩过程中紧急剖宫产率明显提升;与体重合理增加组比,体重增加过多组紧急剖宫产风险增高,体重增加不足组紧急剖宫产风险降低;校正后差异仍然存在。结论:孕前BMI和妊娠期体重增加水平均与阴道分娩过程中紧急剖宫产发生明显相关;美国医学研究院推荐的妊娠期体重增加标准适用于中国孕妇。

Objective:To investigate the relationship between the risk of emergency cesarean section and the body mass index(BMI) before pregnancy and the weight gain during pregnancy in primipara. Methods:A total of 1 727 full-term,first presentation and single pregnant women in our hospital were collected. According to the mode of delivery,123 cases were divided into observation group(emergency cesarean section during vaginal delivery) and 1 604 cases into control group(vaginal delivery). According to prenatal BMI, 301 cases were divided into low weight group,1 260 cases in normal weight group and 166 cases in overweight/obesity group. According to the level of gestational weight gain, 289 cases were divided into underweight group, 745 cases were divided into reasonable weight gain group and 693 cases were divided into excessive weight gain group. To analyze the risk of emergency cesarean section during vaginal delivery for pregnant women with different BMI and weight gain during pregnancy.Results:The birth weight of newborns in the observation group was significantly higher than that in the control group,and the proportion of newborns older than gestational age was significantly higher than that in the control group(P<0.01).With the increase of BMI before pregnancy, the rate of emergency cesarean section during vaginal delivery increased significantly;compared with normal weight group, the risk of emergency cesarean section in overweight/obese group increased, while the risk of emergency cesarean section in low weight group decreased.With the increase of weight gain during pregnancy, the rate of emergency cesarean section increased significantly during vaginal delivery;compared with the group with reasonable weight gain, the risk of emergency cesarean section increased in the group with excessive weight gain, and decreased in the group with insufficient weight gain;the difference after correction still exists.Conclusion:Pre-pregnancy BMI and gestational weight gain are significantly correlated with emergency cesarean section during vaginal delivery. The gestational weight gain standard recommended by American Medical Research Institute is suitable for Chinese pregnant women.