1113例高龄妇女的围产结局分析

Analysis of perinatal outcomes in 1113 women of advanced maternal age

目的通过系统分析围产结局,为高龄妇女围生期健康管理提供更详细和精准的数据参考。方法回顾分析2013-2018年该院诊治的9418例孕产妇资料,其中自然妊娠5040例、助孕妊娠4378例;跟踪目标人群的整个妊娠期经过,并对围生期母儿的各种病理状况进行了比较。结果高龄组(>35岁)1113例,平均年龄(37.6±2.5岁),其中自然妊娠354例(31.8%),助孕妊娠759例(68.2%)。适龄组(≤35岁)8305例,平均年龄(29.1±3.1)岁;其中自然妊娠4686例(56.4%),助孕妊娠3619例(43.6%)。高龄组产后出血、前置胎盘的发生率较适龄组明显升高,而胎膜早破、新生儿入院的发生率明显下降(P<0.05)。高龄组助孕妊娠产后出血、妊娠期高血压(PIH)、NICU发生率明显高于自然妊娠,而先兆子痫、胎膜早破、新生儿平均体重、新生儿住院、死产的发生率则低于自然妊娠(P<0.05)。适龄组助孕妊娠产后出血、前置胎盘、PIH、NICU、早产、低体重儿的发生率明显高于自然妊娠,而胎膜早破的发生率则低于自然妊娠(P<0.05)。与适龄组比较,高龄组助孕妊娠前置胎盘发生率及自然妊娠前置胎盘、PIH、先兆子痫、早产、低体重儿发生率更高(P<0.05)。高龄组剖宫产率明显升高(P<0.05)。两组新生儿畸形率发生率比较,差异无统计学意义(P>0.05)。结论人工助孕可能是高龄女性围产管理独立的高危因素。

Objective To provide detailed data for perinatal health management of elderly women by systematic analysis of perinatal outcomes.Methods A total of 9418 women who delivered in hospital between 2013 to 2018 were included,with 5040 cases who were natural pregnancy and 4378 cases who used assisted reproductive technology(ART)pregnancy.The whole perinatal period was followed up and maternal and child complications were analyzed.Results There were 1113 cases in the elderly group(>35 years old),with an average age(37.6±2.5)years old,of whom 354 cases(31.8%)were naturally pregnant and 759 cases(68.2%)were ART pregnancy.There were 8305 cases in the age-appropriate group(≤35 years old),with an average age of(29.1±3.1)years old,of whom 4686 cases(56.4%)were natural pregnancy and 3619 cases(43.6%)were ART pregnancy.The incidence of postpartum hemorrhage and placenta previa in the elderly group was significantly higher than that in the age-appropriate group,while the incidence of premature rupture of membranes and neonatal admission was significantly decreased(P<0.05).The incidence of postpartum hemorrhage,gestational hypertension(PIH),and NICU in the elderly group with ART pregnancy was significantly higher than those with natural pregnancy,while the incidence of preeclampsia,premature rupture of membranes,average newborn weight,newborn hospitalization,and stillbirth was lower than those with natural pregnancy(P<0.05).In the age-appropriate group,the incidence of postpartum hemorrhage,placenta previa,PIH,NICU,premature birth,and low birth weight infants with ART pregnancy was significantly higher than those with natural pregnancy,while the incidence of premature rupture of membranes was lower than that with natural pregnancy(P<0.05).Compared with the age-appropriate group,the incidence of placenta previa with ART pregnancy and the incidence of placenta previa,PIH,preeclampsia,premature delivery,and low birth weight with natural pregnancy were higher in the elderly group(P<0.05).The cesarean section rate in the elderly group increased(P<0.05).There was no significant difference in the incidence of neonatal deformity between the two groups(P>0.05).Conclusion ART might be a high,independent risk factors in the perinatal management for elder women.