河南省早产儿出生状况及早产原因的多中心研究

A multicenter study of the birth condition of preterm infants and the causes of preterm birth in Henan Province,China

目的了解河南省早产儿出生状况及早产原因,为早产防治提供理论依据。方法对河南省17地市53家医院2019年1月1日至12月31日产科分娩的活产早产儿进行流行病学调查,了解早产儿发生率、胎龄和出生体重分布、产前糖皮质激素使用及早产原因构成等情况。结果53家医院早产儿发生率为5.84%(12406/212438)。胎龄<28周、28~<32周、32~<34周、34~<37周早产儿比例分别为1.58%(196/12406)、11.46%(1422/12406)、15.18%(1883/12406)、71.78%(8905/12406)。出生体重<1000 g、1000~<1500 g、1500~<2500 g、2500~<4000 g、≥4000 g的比例分别为1.95%(240/12313)、8.54%(1051/12313)、49.53%(6099/12313)、39.59%(4875/12313)、0.39%(48/12313)。自然分娩占28.76%(3568/12406),剖宫产占70.38%(8731/12406)。早产儿产前糖皮质激素使用率为52.52%(6293/11983),其中胎龄<34周早产儿使用率为68.69%(2319/3376)。医源性早产是导致早产的首位原因,其次是自发性早产和胎膜早破性早产,分别占40.06%(4915/12270)、30.16%(3701/12270)、29.78%(3654/12270)。医源性早产前3位原因依次是妊娠期高血压疾病[47.12%(2316/4915)]、胎儿宫内窘迫[22.85%(1123/4915)]、前置胎盘/胎盘早剥[18.07%(888/4915)]。结论河南省早产儿发生率处于相对较低水平,晚期早产儿占比较高。医源性早产是导致该省早产发生的主要原因,妊娠期高血压疾病和胎儿宫内窘迫是医源性早产的主要原因。

Objective To investigate the birth condition of preterm infants and the causes of preterm birth in Henan Province,China,and to provide a basis for the prevention and treatment of preterm birth.Methods An epidemiological investigation was conducted for live-birth preterm infants who were born in 53 hospitals in 17 cities of Henan Province from January 1,2019 to December 31,2019 to investigate the incidence rate of preterm birth,the distribution of gestational age and birth weight,the use of antenatal glucocorticoids,and the causes of preterm birth.Results The incidence rate of preterm birth was 5.84%(12406/212438)in the 53 hospitals.The proportions of preterm infants with gestational ages of<28 weeks,28-<32 weeks,32-<34 weeks,and 34-<37 weeks were 1.58%(196/12406),11.46%(1422/12406),15.18%(1883/12406),and 71.78%(8905/12406)respectively.The proportions of preterm infants with birth weights of<1000 g,1000-<1500 g,1500-<2500 g,2500-<4000 g,and≥4000 g were 1.95%(240/12313),8.54%(1051/12313),49.53%(6099/12313),39.59%(4875/12313),and 0.39%(48/12313)respectively.The infants born by natural labor accounted for 28.76%(3568/12406),and those born by cesarean section accounted for 70.38%(8731/12406).The rate of use of antenatal glucocorticoids was 52.52%(6293/11983)for preterm infants and 68.69%(2319/3376)for the preterm infants with a gestational age of<34 weeks.Iatrogenic preterm labor was the leading cause of preterm birth[40.06%(4915/12270)],followed by spontaneous preterm birth[30.16%(3701/12270)]and preterm birth due to premature rupture of membranes[29.78%(3654/12270)].The top three causes of iatrogenic preterm birth were hypertensive disorders of pregnancy[47.12%(2316/4915)],fetal intrauterine distress[22.85%(1123/4915)],and placenta previa/placental abruption[18.07%(888/4915)].Conclusions There is a relatively low incidence rate of preterm birth in Henan Province,and late preterm infants account for a relatively high proportion.Iatrogenic preterm birth is the main cause of preterm birth in Henan Province,and hypertensive disorders of pregnancy and fetal intrauterine distress are the main causes of iatrogenic preterm birth.