三孩政策后孕产妇妊娠特征、分娩方式和围生儿结局的临床研究

Study on pregnancy characteristics,delivery modes,and perinatal outcomes of after three-child Policy

目的 探讨三孩政策后妊娠特征、分娩方式和围生儿结局的变化。方法 收集树兰(杭州)医院三孩政策前2020年1月—2021年6月1 049例产妇(对照组)和三孩政策后2022年4月—2023年9月725例产妇(研究组)的临床资料,比较2组人群结构、妊娠合并症、产科并发症、分娩方式和围生儿结局差异。结果 研究组妊娠期糖尿病(18.76%,136例)、胎盘植入(1.93%,5例)、胎儿窘迫(9.79%,71例)、妊娠合并甲状腺功能减退(12.83%,93例)发生率高于对照组[14.68%(154例)、0.76%(8例)、3.53%(37例)、8.77%(92例)],妊娠期肝内胆汁淤积症(1.24%,9例)、妊娠合并乙型病毒性肝炎(2.07%,15例)发生率低于对照组[2.67%(28例)、3.72%(39例),P<0.05];研究组阴道助产率大于对照组,瘢痕子宫经阴道分娩率小于对照组(P<0.05);研究组初产妇与二孩产妇剖宫产率小于对照组,三孩产妇剖宫产率高于对照组(P<0.05)。研究组非医学指征剖宫率及二孩和三孩产妇非医学指征剖宫率均高于对照组,初产妇非医学指征剖宫率均低于对照组(P<0.05);研究组产后出血、产后贫血、低蛋白血症、巨大儿、新生儿窒息发生率均高于对照组(P<0.05)。结论 三孩政策后生育的主要人群仍以初产妇、二孩产妇为主,二孩高龄产妇更多见,部分合并症/并发症和围生儿不良结局增多。

Objective To examine changes in pregnancy characteristics,mode of delivery and perinatal outcomes following the three-child policy.Methods We retrospectively collected clinical data from 1 049 parturients from Shulan(Hangzhou) Hospital who gave birth between January 2020 and June 2021(control group) before the three-child policy and 725 parturients who gave birth between April 2022 and September 2023(study group) after the policy.We compared the demographics,pregnancy complications,obstetric complications,mode of delivery and perinatal outcomes of the two groups.Results The incidences of gestational diabetes mellitus(18.76%,136 cases),placenta accreta(1.93%,5 cases),fetal distress(9.79%,71 cases),and pregnancy associated with hypothyroidism(12.83%,93 cases) were significantly higher in the study group those in the control group [14.68%(154 cases),0.76%(8 cases),3.53%(37 cases),8.77%(92 cases),P<0.05].The incidences of intrahepatic cholestasis of pregnancy(1.24%,9 cases) and pregnancy combined with hepatitis B(2.07%,15 cases) were significantly lower those in the control group [2.67%(28 cases),3.72%(39 cases),P<0.05].The rate of vaginal assisted delivery in the study group was higher than that in the control group,whereas the rate of vaginal delivery in women with scarred uterus was lower than that in the control group(P<0.05).The rates of caesarean section for first and second births in the study group were significantly lower than those in the control group,while the rate of caesarean section for third birth was significantly higher than that in the control group(P<0.05).The non-medical indication cesarean section rate and the non-medical indication cesarean section rate for the second and third births in the study group were significantly higher than those in the control group,whereas the non-medical indication cesarean section rate for the first births was significantly lower those that in the control group(P<0.05).The incidences of postpartum hemorrhage,postpartum anemia,hypoproteinemia,macrosomia and neonatal asphyxia were higher in the study group than in the control group(P<0.05).Conclusion The main birth population after the implementation of the three-child policy remains first and second births,with a higher number of older second births.Some pregnancy complications,obstetric complications and adverse perinatal outcomes have increased.