三孩产妇的妊娠特征和分娩方式及围生儿结局的研究

Study on pregnancy characteristics,delivery mode,and perinatal outcomes of women with third-child

目的:探讨三孩产妇的妊娠特征、分娩方式及围生儿结局特点,为三孩孕产妇围产期管理提供参考。方法:选取2019年3月-2023年2月住院分娩的1774例产妇,根据产次分为二孩产妇组和三孩产妇组,比较两组产妇人群特征、妊娠合并症、产科并发症、分娩方式和围生儿结局。结果:二孩产妇821例,占46.3%,三孩产妇80例,占4.5%。三孩产妇组≥35岁占比、孕次、流产次数、第一、二孩生育间隔、巨大儿分娩史占比、妊娠前超重或肥胖占比均高于二孩产妇组(P<0.05),文化程度也存在统计学差异(P<0.05);三孩产妇第二、三孩的生育间隔明显短于第一、二孩(t=2.621,P=0.010)。三孩产妇组妊娠期高血压疾病、妊娠期糖尿病、前置胎盘、胎盘植入、妊娠期肝内胆汁淤积症、产后出血、宫颈裂伤、低蛋白血症、产褥感染的发生率明显高于二孩产妇组(P<0.05)。三孩产妇组剖宫产率、中转剖宫产率、非医学指征剖宫产率均显著高于二孩产妇组(P<0.05)。各类医学指征的剖宫产中,三孩产妇组瘢痕子宫剖宫产率低于二孩产妇组,而胎儿窘迫、前置胎盘、胎位异常、巨大儿的剖宫产率则高于二孩产妇组(P<0.05)。与二孩产妇组比较,三孩产妇组巨大儿发生率显著增高(P<0.05)。结论:三孩产妇较二孩产妇具有更复杂的人群特征,母婴并发症和剖宫产率均有所增加,需加强孕期管理,改善不良妊娠结局,促进母婴健康。

Objective:To investigate the characteristics of pregnancy,delivery mode,and perinatal outcomes of women with third-child,and to provide the references for the perinatal management of these women.Methods:A total of 1774 women who had given birth in hospital from March 2019 to February 2023 were selected and were divided into 821 women with second-child in group A and 80 women with third-child in group B according to the number of children of the women.The characteristics,pregnant comorbidities,obstetric complications,modes of delivery,and perinatal outcomes of the women were compared between the two groups.Results:There were 821 women in group A,and accounting for 46.3%.There were 80 women in group B,and accounting for 4.5%.The proportion of women with≥35 years old,the number of gravidity,the number of abortion,the birth interval of the first and the second child,and the proportions of the macrosomia delivery history and the overweight or obesity before pregnancy of the women in group B were significantly higher than those of the women in group A,and the education level of the women in group B had significantly different from that of the women in group A(P<0.05).The birth interval of the second and the third children of the women in group B was significantly shorter than that of the first and the second children(t=2.621,P=0.010).The incidences of hypertensive disorders of pregnancy,gestational diabetes mellitus,placenta previa,placenta accreta,intrahepatic cholestasis of pregnancy,postpartum hemorrhage,cervical laceration,hypoproteinemia,and puerperal infection of the women in group B were significantly higher than those of the women in group A(P<0.05).The rates of cesarean section,transfer to cesarean section,and cesarean section without medical indication of the women in group B were significantly higher than those of the women in group A(P<0.05).In the women with cesarean section caused by various medical indications in the two groups,the rate of cesarean section caused by scarred uterus of the women in group B was significantly lower than that of the women in group A,while the rate of cesarean section caused by fetal distress,placenta previa,abnormal fetal position,or macrosomia of the women in group B was significantly higher than that of the women in group A(P<0.05).The incidence of macrosomia in group B was significantly higher than that of the women in group A(P<0.05).Conclusion:The women with third-child have more complex demographic characteristics than those of the women with second-child.Both the maternal and infant complications rate and the cesarean section rate of the women with third-child have increased.It is necessary to strengthen the perinatal pregnancy management of the women with third-child in order to improve their adverse pregnancy outcomes and promote the maternal and infant health.