不同孕周阴道试产失败的高龄孕妇母婴结局及影响因素分析

Analysis on maternal and infantile outcomes of pregnant women of advanced maternal age failing in vaginal trial production at different gestational weeks and the influencing factors

目的分析不同孕周阴道试产失败的高龄孕妇母婴结局及影响因素。方法选取2020年1月—2021年8月杭州市妇产科医院收治的80例阴道试产失败的高龄孕妇,根据分娩孕周分为37~<40周组(37例)和≥40周组(43例)。比较两组临床资料、母婴结局,并对围生儿不良结局进行单因素与多因素logistic回归分析,构建logistic回归预测模型,采用受试者工作特征曲线(ROC)和曲线下面积(AUC)分析logistic回归模型预测围生儿不良结局的价值。结果37~<40周组和≥40周组产妇不良事件比较,差异均无统计学意义(均P>0.05);≥40周组围生儿不良事件总发生率高于37~<40周组(P<0.05)。多因素logistic回归分析显示:分娩孕周≥40周者发生围生儿不良结局的风险是37~<40周者的2.837倍,第二产程转为剖宫产者发生围生儿不良结局的风险是第一产程者的2.452倍,规律产检者发生围生儿不良结局的风险是未规律产检者的0.495倍,有妊娠并发症者发生围生儿不良结局的风险是无妊娠并发症者的3.673倍(均P<0.05)。logistic回归预测方程:Logit(P)=-5.169+1.043×分娩孕周+0.897×中转剖宫产的产程-0.704×规律产检+1.301×妊娠并发症。ROC曲线显示:logistic回归模型预测围生儿不良结局的AUC为0.862(95%CI:0.767~0.929),当Logit(P)为2.54时,预测围生儿不良结局的灵敏度为95.65%,特异度为71.93%。结论高龄孕妇不同孕周阴道试产失败不影响产妇结局,但孕周≥40周会增加围生儿不良结局风险,中转剖宫产的产程、规律产检及妊娠并发症是围生儿结局的相关影响因素,对存在以上特征的孕妇应充分评估,选取恰当的分娩孕周和分娩方式。

Objective To analyze maternal and infantile outcomes of pregnant women of advanced maternal age failing in vaginal trial production at different gestational weeks and the influencing factors.Methods From January 2020 to August 2021,80 pregnant women of advanced maternal age failing in vaginal trial production treated in Hangzhou Obstetrics and Gynecology Hospital were selected and divided into 37-40-week group(excluding 40-week,37 cases)and equal or more than 40-week group(43 cases)according to delivery gestational week.The clinical data,maternal and infantile outcomes in the two groups were compared,the adverse reactions of perinatal infants were analyzed by univariate and multivariate logistic regression analysis,logistic regression model was established,receiver operating characteristic(ROC)curve and area under ROC curve were used to analyze the value of logistic regression model in predicting adverse reactions of perinatal infants.Results There was no statistically significant difference in maternal adverse events between 37-40-week group(excluding 40-week)and equal or more than 40-week group(P>0.05),the total incidence rate of perinatal adverse events in equal or more than 40-week group was statistically significantly higher than that in 37-40-week group(excluding 40-week)(P<0.05).Multivariate logistic regression analysis showed that the risk of perinatal adverse outcome in equal or more than 40-week group was 1.837 times more than that in 37-40-week group(excluding 40-week),the risk of perinatal adverse outcome in cases transition to cesarean section at the second stage of labor was 1.452 times more than that in cases transition to cesarean section at the first stage of labor,the risk of perinatal adverse outcome in cases receiving regular prenatal examination was 0.495 times as high as the cases not receiving regular prenatal examination,the risk of perinatal adverse outcome in cases with pregnancy complications was 2.673 times more than that in cases without pregnancy complications(all P<0.05).Logistic regression prediction equation:logit(P)=-5.169+1.043×delivery gestational week+0.897×stage of transition to cesarean section-0.704×regular prenatal examination+1.301×pregnancy complication.ROC curve showed that AUC of logistic regression model in predicting perinatal adverse outcome was 0.862(95%CI:0.767-0.929),when logit(P)was 2.54,the sensitivity and specificity of predicting perinatal adverse outcome were 95.65%and 71.93%,respectively.Conclusion The failure of vaginal trial production in different gestational periods of pregnant women of advanced maternal age does not affect maternal outcome,but gestational age equal or more than 40 weeks will increase the risk of perinatal adverse outcomes,the stage of transition to cesarean section,regular prenatal examination,and pregnancy complication are related influencing factors of perinatal outcome,the pregnant women with the above characteristics should be fully evaluated,and appropriate gestational week and delivery mode should be selected.