≤34周早产剖宫产69例分析及近远期并发症随访

The analysis of 69 less than 34 weeks' gestation cesarean cases of premature delivery and the follow-up of complications

目的 探讨早产分娩方式对≤孕 34周早产儿的近远期并发症影响及寻求早产的最佳分娩途径。方法 6 9例住院的≤孕 34周剖宫产病例与随机抽取同期同孕周的阴道分娩病例 93例进行回顾性分析 ,比较两种分娩方式对孕妇的影响及早产儿近期并发症 (包括新生儿窒息、新生儿呼吸窘迫综合征、颅内出血和死亡 )和远期影响 (包括身高、综合学习能力 )。结果 妊高征组的窒息率、新生儿呼吸窘迫综合征 (NRDS)发生率较前置胎盘组低(P <0 0 5 ) ;臀位分娩时剖宫产组的预后较阴道分娩好 (P <0 0 5 ) ;剖宫产组出生的早产儿重度窒息率 ,NRDS、脑出血发生率、病死率均低于阴道分娩组 (P <0 0 5 ) ,但综合学习能力比率较高 ;轻度窒息率、缺血缺氧性脑病 (HIE)及目前身高两组差异无显著性 (P >0 0 5 )。结论 随着NICU发展及新生儿救治水平的提高 ,剖宫产不是低体重早产儿的禁忌证 ,在合并母儿病理产科的情况下 ,及时转运至有条件的医院 。

Objective To investigate the effect of different delivery mode on premature labor less than 34-week gestation.Methods 162 cases from 1994 to 2002 were enrolled in the study, 69 cases were delivered by cesarean section (cesarean) and 93 cases by vaginal delivery with same gestational age. The influence of the two delivery modes on short term complications(including neonatal asphyxia, neonate respiratory distress syndrome(NRDS), intracranial hemorrhage and death) and long-term complications(including height,body weight,colligatial learning capacity) were compared. Results The incidence of asphyxia and NRDS in pregnancy-induced hypertesnsion(PIH) decreased significantly in comparation with that of placenta previa( P <0 05).The prognosis of premature labor of cesarean cases (breech delivery) was better than that of vaginal delivery cases( P <0 05). The incidence of severe asphyxiation, NRDS, cerebral hemorrhage and mortality of premature baby of cesarean decreased significantly in comparation with that of vaginal delivery( P <0 05). Colligation learning ability in cesarean was better than that of vaginal delivery( P <0 05). There was no statistic difference in height and in cidence of mild asphyxia and HIE between cesarean and vaginal delivery( P >0 05). Conclusion With the development of NICU and improvement of treatment, the cesarean was not the contraindication of low body weight premature baby. In pathological obstertric, cesarean was more advantageous than vaginal delivery for preuention of severel complications of premature baby.