妊娠足月高龄初产妇的分娩方式及对妊娠结局的影响

Effects of modes of delivery on pregnancy outcomes of primiparas of advanced maternal age after 37 weeks

目的探讨妊娠37周后高龄初产妇的分娩方式及对妊娠结局的影响。方法采取回顾性研究的方法,选取2018年1-7月在首都医科大学附属北京妇产医院妊娠37周后分娩的高龄初次分娩孕妇,收集孕妇年龄、孕次、不良孕产史、妊娠合并症及并发症、孕周、分娩方式、胎儿窘迫、新生儿窒息率等信息,并进行统计分析。结果 746例分娩中,303例(40. 62%)选择剖宫产终止妊娠,443例(59. 38%)阴道试产。阴道试产中,75例(16. 93%)中转剖宫产,368例(83. 07%)经阴道分娩,其中38例(10. 32%)产钳助产。阴道试产中,35～37岁和≥38岁年龄段,中转剖宫产率分别是17. 24%和15. 15%(P=0. 870),产钳助产率分别是7. 43%和15. 15%(P=0. 021)。择期剖宫产、阴道试产失败中转剖宫产、阴道分娩组中胎儿窘迫发生率分别为5. 30%、40. 00%和21. 47%,P=0. 000。结论 38岁以上的高龄初产妇阴道试产并不增高中转剖宫产的概率;阴道试产失败中转剖宫产的胎儿窘迫率虽然增高,但是新生儿窒息并未增加;由此可见,高龄初产妇经过产前充分评估,无阴道试产禁忌情况下,多数均能经阴道分娩。

Objective To explore the cesarean section rate and the clinical features of trial of vaginal delivery in primiparas of advanced maternal age after 37 weeks. Methods A retrospective study was conducted of the primiparas of advanced maternal age after37 weeks of pregnancy in Beijing Obstetrics and Gynecology Hospital between January and July 2018. Data on the age,gravidity,history of adverse pregnancy,pregnancy complications,gestational weeks,mode of delivery,fetal distress,neonatal asphyxia of these primiparas was collected for statistical analysis. Results Among the 746 cases of delivery,303 cases( 40. 62%) chose cesarean section and 443 cases( 59. 38%) requested trial of vaginal delivery,75 of whom( 16. 93%) were transferred to cesarean section,368( 83. 07%) had successful vaginal delivery and 38 cases( 10. 32%) delivered by forceps. In the group aged 35 to 37 and the group above 38 years old,the rate of transferred cesarean section was 17. 24% and 15. 15%,respectively,( P = 0. 870) and the rate of forceps delivery was 7. 43% and 15. 15%,respectively( P = 0. 021). The rates of neonatal asphyxia in the groups of elective cesarean section,transferred cesarean section and normal vaginal delivery were 5. 30%,40. 00% and 21. 47%,respectively( P = 0. 000). Conclusions The chances of transferred cesarean section are not increased in the group above 38 years old. The rate of fetal distress in the transferred cesarean section group increases,but the rate of neonatal asphyxia does not. After adequate assessment,most of the primiparas of advanced maternal age after 37 weeks of pregnancy can have successful vaginal delivery.