二胎孕妇不良分娩结局及其影响因素分析

Adverse delivery outcomes and its influencing factors of second-born pregnant women

目的分析开封市二胎孕妇不良分娩结局发生情况及相关因素,为制定干预措施,避免不良母婴结局提供依据。方法以2017年1月至2019年12月在开封市某医院产科建立生育档案并分娩的二胎孕妇为研究对象,收集其基本情况及孕期并发症,并匹配分娩相关资料,采用描述流行病学分析方法进行分析,并采用单、多因素分析方法对不良分娩结局影响因素进行分析。结果本研究共纳入符合研究条件并与产科资料匹配完整的二胎孕妇2208人,年龄23~43岁,平均年龄(30.93±5.71)岁。孕前BMI 18.5~23.9者占66.17%。文化程度以中专或高中为主(占39.67%)。家庭年收入以5~9万元为主(占50.68%)。1689人为正常分娩结局,519例发生不良分娩结局,发生率为23.51%。其中死胎死产21例(占4.05%),早产183例(35.26%),巨大儿81例(15.61%),低出生体重儿87例(占16.76%),新生儿窒息57例(占10.98%),新生儿呼吸窘迫综合征66例(占12.72%),新生儿畸形24例(占4.62%)。多因素Logistic回归分析结果显示,年龄35~38、39~43岁(OR=5.083、10.433)、孕前BMI≥24.0(OR=3.375)、流产次数≥3次(OR=3.725)、妊娠期高血压(OR=2.452)、妊娠期糖尿病(OR=4.191)、胎儿宫内窘迫(OR=2.040)、胎膜早破(OR=7.338)是二胎孕妇不良分娩结局的危险因素。结论开封市二胎孕妇不良分娩结局发生率较高,不良结局以早产为主。不良分娩结局影响因素较多,建议加强二胎孕妇孕期保健教育,针对高龄、具有并发症的二胎孕妇制定适应性生育计划,筛查高危妊娠因素及加强临床干预管理,减少不良妊娠及分娩结局,确保母婴安全。

Objective To analyze the occurrence and related factors of adverse delivery outcomes of second-born pregnant women in Kaifeng City,and provide a basis for formulating intervention measures to avoid adverse maternal and infant outcomes.Methods A second-born pregnant woman who had established a fertility file and gave birth in the obstetrics department of a hospital in Kaifeng from January 2017 to December 2019 was selected as the research object.The basic conditions and complications of pregnancy were collected,and the relevant data of delivery were matched.Descriptive epidemiological analysis was used to analyze,and univariate and multivariate analysis were used to analyze the factors affecting the adverse delivery outcomes.Results A total of 2208 second-born pregnant women who met the research conditions and matched the obstetric data were included in the study,aged 23-43 years old,with an average age of(30.93±5.71)years.The pre-pregnancy BMI of 18.5~23.9 kg/m^2 accounted for 66.17%.Secondary specialized school or high school was the main educational level(39.67%).The annual household income was mainly 50,000 to 90,000 yuan(50.68%).1689 had a normal delivery outcome,and 519 had an adverse delivery outcome,with an incidence rate of23.51%.Among them,21 cases were stillbirths(4.05%),183 cases(35.26%)were born prematurely,81 cases(15.61%)were giant infants,87 cases(16.76%)were low birth weight infants,57 cases(10.98%)were neonatal asphyxia,66 cases(12.72%)were neonatal respiratory distress syndrome,and 24 cases(4.62%)were neonatal deformity.Multivariate logistic regression analysis showed that ages were 35-38,39-43 years(OR=5.083,10.433),pre-pregnancy BMI≥24.0(OR=3.375),abortion frequency≥3 tines(OR=3.725),gestational hypertension(OR=2.452),gestational diabetes(OR=4.191),fetal distress(OR=2.040),and premature rupture of membranes(OR=7.338)were risk factors for adverse delivery outcomes in second-born pregnant women.Conclusion The incidence of adverse delivery outcomes among second-born pregnant women in Kaifeng is relatively high,and premature delivery is the main adverse outcome.There are many factors influencing adverse delivery outcomes.It is recommended to strengthen health education for secondborn mothers during pregnancy,develop adaptive birth plans for advanced age parturient women and second-born pregnant women with complications,screen for high-risk pregnancy factors and clinical intervention management,reduce adverse pregnancy and delivery outcomes,and ensure maternal and infant safety.