重度肥胖产妇分娩方式对新生儿不良结局的影响

Effect of delivery mode of severely obese women on adverse outcomes of their newborns

目的探讨重度肥胖产妇(BMI≥35kg/m2)不同分娩方式对新生儿不良结局的影响。方法应用回顾性队列研究方法,收集2011年1月至2021年1月在十堰市妇幼保健院住院分娩的重度肥胖产妇4827例,以及新生儿病历资料。根据产妇分娩方式将其分为阴道试产组(2789例)与计划剖宫产组(2038例),并进一步将阴道试产组分为阴道分娩组(2152例)与中转剖宫产组(637例)。比较并分析接受阴道试产与计划剖宫产,以及阴道分娩与中转剖宫产产妇的新生儿不良结局状况。结果在2789例阴道试产产妇中,阴道试产中转剖宫产为637例,中转剖宫产率为22.84%。阴道试产组产妇的年龄、受教育年限、孕次、产次、分娩孕周、新生儿出生体重与计划剖宫产组比较差异均有统计学意义(t=6.441~19.129,P<0.05);阴道试产组产妇的产前定期检查、初产妇、孕前高血压、妊娠期高血压疾病、孕前糖尿病、妊娠期糖尿病、孕前冠心病、新生儿男性的分布与计划剖宫产组比较差异均有统计学意义(χ^(2)=13.136~388.593,P<0.05)。阴道试产组新生儿入住新生儿重症监护病房(NICU)的比例明显低于计划剖宫产组,差异有统计学意义(χ^(2)=30.063,P<0.05);在阴道试产组的阴道分娩组与中转剖宫产组中,阴道分娩组的新生儿1min Apgar评分≤7分、5min Apgar评分≤7分及入住NICU的分布均明显低于中转剖宫产组,差异均有统计学意义(χ^(2)值分别为7.656、12.052、101.262,P<0.05)。阴道试产与计划剖宫产对新生儿不良结局均无明显影响(P>0.05);相较于计划剖宫产,阴道试产中的阴道分娩是新生儿入住NICU的保护因素(OR=0.785,95%CI:0.626~0.985,P<0.05);相较于计划剖宫产,阴道试产中的中转剖宫产是新生儿1min Apgar评分≤7分、5min Apgar评分≤7分、入住NICU的危险因素(OR=2.017,95%CI:1.221~3.331,P<0.05;OR=2.293,95%CI:1.444~3.642,P<0.05;OR=1.754,95%CI:1.099~2.799,P<0.05)。结论与计划剖宫产比较,阴道试产并未增加新生儿不良结局的发生率,成功的阴道试产可以降低新生儿不良结局的发生率,而失败的阴道试产则不利于新生儿结局。

Objective To explore effects of different delivery modes of severely obese women(BMI≥35 kg/m^(2))on adverse outcomes of their newborns.Methods In retrospective cohort study method,clinical data of 4827 severely obese parturients who delivered in Shiyan Municipal Maternity and Child Health Hospital and medical records of their newborns over a period from January 2011 to January 2021 were selected.According to mode of delivery,the parturients were divided into trial vaginal delivery group(2789 cases)and planned cesarean section group(2038 cases),and the parturients in the trial vaginal delivery group were further divided into vaginal delivery group(2152 cases)and transitional cesarean section group(637 cases).The adverse outcomes of the newborns were compared between the trial vaginal delivery group and the planned cesarean section group,and between the vaginal delivery group and the transitional cesarean section group.Results Among 2789 parturients who received trial vaginal delivery,637 parturients were forced to receive cesarean section,and the conversion rate was 22.84%.There were statistically significant differences in age,education span,gravidity,parity,gestational week at delivery and birth weight of the newborn between the trial vaginal delivery group and the planned cesarean section group(t=6.441-19.129,all P<0.05),As well,there were statistically significant differences in proportions of receiving prenatal regular examination,primipara,history of pre-gestational hypertension,having hypertensive disorder complicating pregnancy(HDCP),history of pre-gestational diabetes,having gestational diabetes mellitus(GDM),history of pre-gestational coronary heart diseases and male gender of the newborn between the trial vaginal delivery group and the planned cesarean section group(χ^(2)=13.136-388.593,all P<0.05).The proportion of the newborns who admitted to neonatal intensive care unit(NICU)in the trial vaginal group was significantly lower than that in the planned cesarean section group(χ^(2)=30.063,P<0.05).In the trial vaginal delivery group,the proportions of 1 min Apgar score≤7 and 5 min Apgar score≤7 in the vaginal delivery group were significantly lower than those in the transitional cesarean section group(χ^(2)=7.656,12.052 and 101.262 respectively,both P<0.05).Trial vaginal delivery and planned cesarean section both had no significant effects on adverse outcomes of the newborns(both P>0.05).Vaginal delivery was a protective factor for neonatal admission to NICU(OR=0.785,95%CI:0.626-0.985,P<0.05).And conversion from trial vaginal delivery to cesarean section was a risk factor for 1 min Apgar score≤7,5 min Apgar score≤7 and admission to NICU of the newborns(OR=2.017,95%CI:1.221-3.331,P<0.05;OR=2.293,95%CI:1.444-3.642,P<0.05;OR=1.754,95%CI:1.099-2.799,P<0.05).Conclusion Compared with planned cesarean section,trial vaginal delivery does not increase incidence of adverse neonatal outcomes.Compared with planned cesarean section,a successful trial vaginal can reduce incidence of adverse neonatal outcomes,while a failed trial vaginal is not conducive to the neonatal outcomes.