降低生育政策调整后高龄孕产妇围产期风险研究

Study of reducing the perinatal risk of elderly pregnant women after the adjustment of fertility policy

目的:探讨生育政策调整后高龄孕产妇围产期风险的特点,提出降低风险的措施。方法:采集2020年1月1日—2021年12月31日在上海市闵行区中心医院妇产科住院分娩的3660例孕产妇的临床资料,根据孕产妇分娩时年龄分组,≥40岁为高龄1组,35~39岁为高龄2组,<35岁为适龄组。比较三组妊娠期合并症及并发症的发生率、分娩方式和围产儿结局。结果:高龄1组、高龄2组孕产妇的比例分别占1.86%、12.90%。三组妊娠期高血压发生率分别为17.65%、15.16%、6.45%,妊娠期糖尿病发生率分别为22.06%、15.37%、8.15%,子宫肌瘤发生率分别为11.77%、10.11%、4.56%;前置胎盘发生率分别为7.35%、3.79%、0.83%,胎盘早剥发生率分别为4.41%、3.16%、0.67%,产后出血发生率分别为13.24%、10.95%、5.13%。高龄1组和高龄2组妊娠期合并症及并发症的发生率均显著高于适龄组(P<0.001)。三组疤痕子宫剖宫产率分别为36.77%、32.42%、12.29%,高龄1组和高龄2组显著高于适龄组(P<0.001)。三组初次剖宫产率分别为25.00%、24.42%、29.51%,三组间差异无统计学意义(P>0.05)。三组巨大儿出生率分别为11.77%、9.68%、4.33%,早产儿出生率分别为13.24%、10.53%、4.49%,高龄1组和高龄2组显著高于适龄组(P<0.001)。三组新生儿窒息率分别为7.35%、6.95%、3.43%,高龄2组与适龄组间差异有统计学意义(P<0.05)。结论:高龄孕产妇的妊娠期合并症和并发症发生率明显增加,应尽早进行预防及干预,多科协作制定孕期保健管理方案,降低高龄孕产妇尤其是40岁以上的围产期风险,改善围产儿结局,确保母婴安全。

Objective:To explore the characteristics of perinatal risk of elderly pregnant women after the adjustment of fertility policy,and to propose measures to reduce risk.Methods:The clinical data of 3660 pregnant women who gave birth in Shanghai Minhang District Central Hospital from January,2020 to December 30,2021 were collected,and divided into the≥40 years old advanced age group 1,the 35-39 years old advanced age group 2,and the<35 years old suitable age group according to the age group at the time of maternal delivery.The incidence of complications,delivery mode and perinatal outcomes were compared among the three groups.Results:The proportion of pregnant women in the advanced age group 1 and the advanced age group 2 accounted for 1.86%and 12.90%,respectively.The incidence of hypertension in pregnancy in the three groups was 17.65%,15.16%and 6.45%,respectively.The incidence of gestational diabetes mellitus was 22.06%,15.37%and 8.15%,respectively;the incidence of uterine fibroids was 11.77%,10.11%,and 4.56%,respectively;the incidence of placenta previa was 7.35%,3.79%,and 0.83%,respectively;the incidence of placental abruption was 4.41%,3.16%,and 0.67%,respectively;the incidence of postpartum haemorrhage was 13.24%,10.95%and 5.13%,respectively.Incidence of complications during pregnancy in the advanced age group 1 and the advanced age group 2 were significantly higher than those in the suitable age group(P<0.001).The rates of scarred uterine cesarean section in the three groups were 36.77%,32.42%,and 12.29%,respectively,and the rates of scarred uterine caesarean section in the advanced age group 1 and the advanced age group 2 were significantly higher than those in the suitable age group(P<0.001).The rate of primary caesarean section in the three groups was 25.00%,24.42%and 29.51%,respectively,and there was no significant difference among three groups(P>0.05).The birth rates of macrosomia in the three groups were 11.77%,9.68%and 4.33%,respectively,the birth rates of preterm infants were 13.24%,10.53%and 4.49%,respectively,and the birth rates of macrosomia and preterm infants in the advanced age group 1 and the advanced age group 2 group were significantly higher than those in the suitable age group(P<0.001).The neonatal asphyxia rates in the three groups were 7.35%,6.95%,and 3.43%,respectively,and there were statistically significant between the advanced age group 2 and the suitable age group(P>0.05).Conclusion:The incidence of complications and complications during pregnancy in the advanced pregnant age has increased significantly,prevention and intervention should be carried out as soon as possible,the multiple departments develop the pregnancy health care management programs to reduce the perinatal risk of the elderly pregnant women,especially over 40 years old,improve perinatal outcomes,and ensure the safety of mothers and babies.