羊水胎粪污染的高危因素及妊娠结局分析

Analysis of high-risk factors and pregnancy outcomes in patients with meconium-stained amniotic fluid

目的探讨羊水胎粪污染的高危因素,以及胎粪污染程度对妊娠结局的影响。方法选取2020年1月至2021年1月于南京医科大学第一附属医院产科1368例妊娠≥39周阴道分娩的产妇。按照羊水胎粪污染程度分为3组:羊水清组(n=951),羊水Ⅰ、Ⅱ度组(n=252)和羊水Ⅲ度组(n=165)。收集临床资料,比较三组产妇妊娠的一般情况,三组产妇的妊娠结局情况,包括产后出血、新生儿性别、Apgar评分、新生儿重症监护(NICU)转诊、NICU转诊原因等。根据羊水粪染情况进一步分组,羊水清、I度、II度产妇作为对照组(n=1203),羊水Ⅲ度产妇作为研究组(n=165),通过二元logistic回归,分析羊水Ⅲ度污染的高危因素。结果羊水Ⅲ度组分娩孕周、初产妇率均显著高于其他两组(P<0.05)。羊水Ⅰ、Ⅱ度组及羊水Ⅲ度组人工破膜率较羊水清组显著上升(P<0.05),羊水Ⅲ度组侧切率、产后出血率、1minApgdr≤分、新生儿NICU转诊率较另外两组明显升高(P<0.05)。二元logistic回归提示分娩孕周、人工破膜、会阴侧切率与羊水Ⅲ度污染密切相关,分娩孕周为羊水Ⅲ度污染的高危因素(P<0.05)。结论羊水胎粪污染的主要危险因素是分娩孕周,羊水胎粪污染与更高的人工破膜率及会阴侧切率、新生儿窒息、产后出血率、新生儿NICU转诊率有关,因此需积极处理产程、预防产后出血,新生儿娩出后及早进行复苏,减少新生儿窒息发生率。

Objective The article aims to analyze the high-risk factors of meconium-contaminated amniotic fluid and the im‐pact of the degree of contamination on pregnancy outcomes.Methods A total of 1,368 pregnant women who successfully delivered vaginally at≥39 weeks of gestation in the First Affiliated Hospital of Nanjing Medical University from January 2020 to January 2021 were selected.The patients were divided into three groups according to the degree of amniotic fluid meconium contamination:clear am‐niotic fluid group(n=951),amniotic fluid I andⅡdegree-contaminated group(n=252),and amniotic fluidⅢdegree-contaminated group(n=165).Clinical data was collected and compared among the three groups in terms of the general information of the pregnancy and pregnancy outcomes,including postpartum hemorrhage,neonatal sex,Apgar score,neonatal intensive care unit(NICU)referral,and reasons for NICU referral.The patients were further divided into groups according to the degree of meconium contamination of am‐niotic fluid.Patient with clear amniotic fluid,amniotic fluid I and II degree-contaminated were used as the control group(n=1,203),and pregnant women with amniotic fluidⅢdegree-contaminated were used as the study group(n=165).Binary logistic regression anal‐ysis was used to analyze the high-risk factors of amniotic fluid contamination.Results The gestational age of delivery and primigrav‐ida rate in the amniotic fluid gradeⅢgroup were significantly higher than those in the other two groups(P<0.05).The rate of manual rupture of membranes in the amniotic fluid grade I andⅡgroups and the amniotic fluid gradeⅢgroup was significantly higher than that in the amniotic fluid clear group(P<0.05).In the amniotic fluid gradeⅢgroup,the lateral incision rate,postpartum hemorrhage rate,1-min Apgdr≤score,and neonatal NICU referral rate It was significantly higher than the other two groups(P<0.05).Binary logistic regression showed that the gestational age at delivery,artificial rupture of mem‐branes,and episiotomy rate were closely related to gradeⅢamniotic fluid contamination,and the gestational age at delivery was considered to be a high-risk factor for gradeⅢamniotic fluid contamination(P<0.05).Conclusion The main risk factor for meconium-stained amniotic fluid is the gestational age at delivery.Meconium-stained amniotic fluid is associated with a higher rate of artificial rupture of membranes and episiotomy,neonatal asphyxia,postpartum hemorrhage,and neonatal NICU referral rate.Therefore,it is necessary to actively manage the delivery process,prevent postpartum hemorrhage,and resuscitate the newborn as soon as possible after delivery to reduce the incidence of neonatal asphyxia.