可疑巨大儿孕妇孕39周与孕41周引产对妊娠结局的影响

Comparison of the pregnancy outcomes of the induction of labor of pregnant women with suspected macrosomia during 39 gestational weeks and 41 gestational weeks

目的:比较可疑巨大儿孕妇孕39周与孕41周引产的妊娠结局,探讨可疑巨大儿的最佳引产时机。方法:前瞻性选取北京太和妇产医院和北京市上地医院2018年7月1日-2021年6月30日分娩的孕39周产前检查时可疑巨大儿的单胎头位孕妇共726例,按照孕妇个人意愿分组,孕39周行选择性引产为观察组共298例,孕41周前自然临产或孕41周引产为对照组共428例,比较两组母婴结局。结果:观察组剖宫产率(18.8%)低于对照组(45.6%),且观察组分娩孕周(39.3±1.2)、新生儿体重(4030±485g)、巨大儿发生(75.5%)、新生儿5min Apgar评分<7分(3.7%)和新生儿脐血气<7.20(3.0%)发生率均低于对照组(4180±465g、92.5%、5.1%、14.4%)(P<0.05)。结论:可疑巨大儿孕妇孕39周引产,可在不增加母婴不良结局情况下,增加阴道分娩成功率,降低新生儿不良结局风险。

Objective: To explore the best induction timing of pregnant women with suspected macrosomia by comparing the pregnancy outcomes of the women who undergone selective induction of labor during 39 gestational weeks and during 41 gestational weeks. Methods: A controlled prospective clinical trial was conducted to select 726 singleton pregnant women with suspected macrosomia and vertex presentation during 39 gestational weeks in this study from July 1st, 2018 to June 30th, 2021. These women were divided into two groups according to their personal wishes, which included 298 women with selective labor induction during 39 gestational weeks in observation group, and the other 428 women who still hadn’t delivered till 41 gestational weeks and had selective labor induction during 41 gestational weeks in control group. The outcomes of the mothers and infants were observed and compared between the two groups. Results: The rate of cesarean section(18.8%) of the women in the study group was significantly lower than that(45.6%) of the women in the control group. The body weight of newborns(4030±485g), the rate of macrosomia(75.5%),the incidence of neonatal 5 min Apgar score <7 point(3.7%), and the neonatal umbilical artery blood PH <7.20(3.0%) of the women in the observation group were significantly lower than those(4180±465g, 92.5%, 5.1%, and 14.4%) of the women in the control group(P<0.05). Conclusion: For the pregnant women with suspected macrosomia, the selective induction of labor during 39 gestational weeks can increase the rate of their successful vaginal delivery without increasing the incidence of the adverse maternal outcomes, and can reduce the adverse infants outcomes.