“自發性”與“治療性”早產的相關因素及新生兒狀況比較分析

The related factors and newborn status:the“spontaneous”versus the“therapeutic”preterm labor

目的比較“自發性”早產和“治療性”早產的病因、分娩方式和分娩結局,以便提出針對性的預防早產措施,改善新生兒預後。方法選擇2018年1月~2018年12月期間於本院“自發性”早產和“治療性”早產共計124例作為研究對象,回顧性分析兩組早產的相關因素,分析流產史丶早產史丶分娩方式以及在不同孕週分娩的新生兒狀況。結果“自發性”早產和“治療性”早產均存在多種影響因素,其中“胎膜早破”是“自發性”早產的主要影響因素,“不明原因”為次要影響因素。“前置胎盤”為“治療性”早產主要影響因素,其次依次為“多胎妊娠”、“子癇前期”、“胎兒宮内窘迫”、“瘢痕子宮”等。“自發組”妊娠婦女多為陰道分娩(佔比59.3%),“治療組”妊娠婦女均為剖宮產分娩。比較不同孕週極早早產(EP)、早早產(VP)、中度早產(MP)、晚期早產(LP)分娩的新生兒併發症指數,分別為2.50,2.22,0.89和0.63。EP、VP和MP時期併發症,主要是肺透明膜病(RDS)和顱内出血等嚴重併發症。LP時期併發症多為黃疸、濕肺等自限性併發症。“自發性”早產新生兒併發症指數為0.83,“治療性”早產新生兒併發症指數為0.67。結論“自發性”早產和“治療性”早產有不同的病因。“治療性”早產能夠減少新生兒發病比率,對於高危孕婦適當時機終止妊娠,有助於產兒結局。

Objective To compare the causes,mode of delivery and outcome of the“spontaneous”and“therapeutic”preterm birth in order to improve the prognosis of the parturient and the newborns.Methods A total of 124 premature parturient who had their delivery in our hospital from January 2018 to December 2018 were enrolled.Among them,86 cases belonged to the“spontaneous”preterm delivery and 38 cases belonged to the“therapeutic”preterm delivery.Retrospective analysis of the preterm birth related factors,history of abortion/premature birth,mode of delivery and the newborn status at different gestational weeks of the two groups was carried out.Results The“spontaneous”and the“therapeutic”preterm labor had multiple predisposing factors.“Premature rupture of membranes”and“unexplained causes”were the first two main predisposing factors for“spontaneous”preterm birth.“Placenta previa”,“multiple pregnancies”,“preeclampsia”,“intrauterine distress”and“scarreduterus”were predisposing factors for the“therapeutic”preterm birth.Fifty nine percent of the“spontaneous”group women were vaginally delivered.All of the“therapeutic”group women were given cesarean delivery.The newborn complication index(NCI)at EP,VP,MP and LP stage were 2.50,2.22,0.89 and 0.63 respectively.Most of the complications such as respiratory distress syndrome(RDS)and intracranial hemorrhage(ICH)were serious in EP(extremely preterm),VP(verypreterm)and MP(moderate preterm)stages.In contrast,most of the complications in LP(late preterm)were minor and self-limiting,such as newborn jaundice and wet lung disease.The newborn complication index was 0.83 and 0.67 in the“spontaneous”and“therapeutic”group respectively.Conclusion“Spontaneous”and“therapeutic”preterm birth had different causes.“Therapeutic”methods applied to stop pregnancy at an appropriate time point for certain high risk pregnant women would improve the prognosis of both the pregnant women and the premature infants.