Retrospective Cohort Study to Investigate Pregnancy Outcomes in a Population of Advanced Maternal Age Congolese Women of Kinshasa: A Study Protocol

Introduction: Pregnancies at advanced maternal age (AMA) are those occurring after the age of 35 years old. They carry a high risk of maternal-fetal morbidity and mortality, thus constituting a public health problem. Several African countries have reported an upward trend in both the age of childbirth and the frequency of women with AMA over the past 20 years. In the Democratic Republic of Congo (DRC), where maternal and neonatal morbidity and mortality remain very high, data on AMA pregnancies go back more than 20 years. Objective: We propose evaluating obstetrical outcomes among women in AMA in our setting and the associated factors. Methods: This retrospective cohort study will be conducted in two healthcare facilities (ESS) in Kinshasa. The study population will consist of all women who delivered a single fetus after 28 weeks of gestation between January 2012 and December 2022 (10 years) in the selected ESS. The data collected will be analyzed using R software version 4.2.0. Quantitative variables will be summarized as means with standard deviation or medians with interquartile range. Qualitative variables will be presented as proportions (%). Multivariate logistic regression will be used to determine the main maternal-fetal complications associated with AMA and predictors of obstetric outcomes. P Discussion: The high maternal and infant mortality rates in DRC are among the highest in the world. The context of maternal age has become a topic of growing interest due to its potential implications for the health of women and newborns, it is crucial to identify the risk factors associated with obstetric outcomes by identifying obstetrical outcomes associated with advanced maternal age in the DRC. Many Congolese women tend to start their maternity journey at a relatively young age. However, there is also an emerging trend towards delayed childbearing, particularly in urban areas and among women with access to education and family planning services. Conclusion: The results of this study will enable us to update the frequency of AMA pregnancies in our environment. The socio-demographic and clinical profile of these pregnancies will be determined. The main maternal-fetal complications associated with AMA in our setting and the associated factors will be identified.

Obstetric Outcomes in Advanced Maternal Age among Women at King Abdulaziz University Hospital

Background: Advanced maternal age, over 35 years, is a well-known risk factor for poor pregnancy outcomes. It is commonly associated with various pregnancy complications, such as spontaneous miscarriage, preeclampsia/ toxemia, gestational diabetes mellitus, preterm labor, stillbirth, chromosomal abnormalities, and cesarean delivery. Objectives: This study assessed obstetric and neonatal complications associated with advanced maternal age. Methods: We reviewed the medical records of 199 pregnant women over 35 years old at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, from January to June 2022. We gathered data on age, nationality, number of antenatal visits, results of ultrasound scans for dating and viability, nuchal translucency and anatomy surveys, medications and multivitamins taken during pregnancy, smoking status, pregnancy, and fetal complications, and mode of delivery. Results: The prevalence of obstetric complications was 71.4% (preeclampsia/toxemia, 4.5%;antepartum hemorrhage, 4%;postpartum hemorrhage, 1%;and gestational diabetes, 23.1%). The most frequent complication was preterm labor between 34 and 36 weeks (48%), and only 12.6% of all deliveries were associated with fetal and neonatal complications such as congenital anomalies and neonatal jaundice. The prevalence of anemia during pregnancy was 10.1%, 21.1%, and 28.6% in the first, second, and third trimesters, respectively, and pregnancies complicated with antepartum or postpartum hemorrhage were associated with higher rates of anemia in the second trimester. A significant relationship was found between mean maternal age (38.84 ± 2.75 years) and the development of maternal complications (p < 0.05). Newborns with neonatal complications were much more likely to be born to mothers with a history of antepartum hemorrhage and anemia in the second trimester. Conclusion: Our findings confirm that pregnancy at an advanced maternal age is associated with increased overall maternal complications. The most frequent complication was preterm labor (48%). Other complications, such as preeclampsia/toxemia, antepartum hemorrhage, postpartum hemorrhage, gestational diabetes, and anemia, were less frequent in the sample we reviewed.

Intrafollicular Soluble RAGE Benefits Embryo Development and Predicts Clinical Pregnancy in Infertile Patients of Advanced Maternal Age Undergoing In Vitro Fertilization

Soluble receptor for advanced glycation end products（s RAGE） can decoy the toxic AGEs and is considered to be a protective factor.This study aimed to evaluate the correlation between intrafollicular s RAGE levels and clinical outcomes in infertile women of young or advanced maternal age（AMA） undergoing in vitro fertilization（IVF）.A total of 62 young women and 62 AMA women who would undergo IVF were included in this prospective study.The intrafollicular s RAGE concentration was measured to determine its association with the number of retrieved oocytes,fertilized oocytes,high-quality embryos or achievement of clinical pregnancy in young and AMA women,respectively.Besides,correlations between sR AGE and age or follicle-stimulating hormone（FSH） were examined.We found that the intrafollicular s RAGE levels were higher in young patients than those in AMA patients,suggesting that the s RAGE levels were inversely correlated with age.In young patients,sR AGE showed no correlation with the number of retrieved oocytes,fertilized oocytes,high-quality embryos or achievement of clinical pregnancy.But it was found that AMA patients with more retrieved oocytes,fertilized oocytes and high-quality embryos demonstrated higher sR AGE levels,which were a prognostic factor for getting clinical pregnancy independent of age or FSH level.In conclusion,the s RAGE levels decrease with age.Elevated intrafollicular s RAGE levels indicate good follicular growth,fertilization and embryonic development,and successful clinical pregnancy in AMA women,while in young women,the role of s RAGE may not be so predominant.

Adverse pregnancy outcomes in extremely maternal age

Objective: To study the adverse outcome in pregnant women ≤ 16 and ≥ 40 years. Study Design: A total of 1100 cases, 1061 cases of pregnant women ≤ 16 years, 20 - 29 and ≥ 40 years with completed charts between 1st January, 2006 to 31st December, 2010, were enrolled in this study. The patient data includeing demographic data, hospital course, maternal laboratory investigations, maternal complications, placental complications and neonatal outcomes were recorded. SPSS version 14, one-way Anowa, Chi-square and analysis of varience were used to compare the data among two and three groups. Results: Anemia, underlying medical diseases including heart, thyroid and pulmonary diseases, obstetric complications including severe pre-eclampsia and gestational diabetes mellitus, placenta previa and preterm labour;medical administrations including magnesium sulfate, dexamethasone and bricanyl, outcome of deliveries and neonatal outcomes, were different with statistical significance between the 3 groups of pregnant women. Conclusion: Adverse maternal and neonatal outcomes were mostly found in the pregnant women ≤ 16 and ≥ 40 years. Education of contraception, safe sex and effective care during pregnancy of both extremely maternal age groups should be implemented to reduce those poor outcomes.

Genetic counseling, prenatal screening and diagnosis of Down syndrome in the second trimester in women of advanced maternal age： a prospective study

Background The incidence of autosomal trisomy in livebirths is strongly dependent on maternal age. Special consideration is given to the provision of prenatal screening and cytogenetic testing to women of advanced maternal age （AMA）. The aim of this study was to evaluate the effectiveness of second trimester prenatal screening and amniocentesis for Down syndrome （DS） and compare the trends of choice of screening and amniocentesis among AMA women. Methods A total of 5404 AMA patients with natural singleton pregnancy were recruited for this prospective study from January 2008 to December 2010. The gestational weeks were from 15 weeks to 20~6 weeks. The patients referred were grouped into a screening group （2107 cases） and an amniocentesis group （3297 cases） by their own decision. The prevalence of DS was compared between the two groups by chi-square test. Choice rates for each maternal age with trends were compared by regression analysis. Results There were 18 cases of fetal DS detected in the screening group with a prevalence of 8.54%o （18/2107）. Twenty- five cases of fetal DS were diagnosed in the amniocentesis group with a prevalence of 7,58%0 （25/3297）. No statistical difference was observed in the prevalence of DS between the screening and amniocentesis group （P=0.928）. The invasive testing rate for DS in the amniocentesis group was 5.54 times higher than that of the screening group （1/131.88 vs. 1/23.78）. With the increase of the maternal age, the choice of amniocentesis increased while the choice of the screening showed an opposite trend. The choice of the AMA women between the screening and amniocentesis was significantly age relevant （P=0.012）. Conclusions The second trimester serum screening age alone to screen for DS. We suggest educating screening and amniocentesis options. in combination with maternal age was more effective than maternal the patients by recommending AMA women be informed of both

Reduced cell invasion may be a characteristic of placental defects in pregnant women of advanced maternal age at single-cell level

The mechanisms underlying pregnancy complications caused by advanced maternal age(AMA)remain unclear.We analyzed the cellular signature and transcriptomes of human placentas in AMA women to elucidate these mechanisms.Placental tissues from two AMA women and two controls were used for single-cell RNA-sequencing(scRNA-seq).Controls consisted of AMA women who did not experience any pregnancy complications and pregnant women below the age of 35 years without pregnancy complications.Trophoblast cells were obtained from the placentas of another six pregnant women(three AMA women and three controls),and in-vitro transwell assays were conducted to observe the cell invasion ability.Thirty additional samples(from 15 AMA women and 15 controls)were analyzed to verify the specific expression of serine protease inhibitor clade E member 1(SERPINE1).Preliminary study of the role of SERPINE1 in cell invasion was carried out with HTR8-S/Vneo cells.High-quality transcriptomes of 27607 cells were detected.Three types of trophoblast cells were detected,which were further classified into eight subtypes according to differences in gene expression and Gene Ontology(GO)function.We identified 110 differentially expressed genes(DEGs)in trophoblast cells between the AMA and control groups,and the DEGs were enriched in multiple pathways related to cell invasion.In-vitro transwell assays suggested that the invading trophoblast cells in AMA women were reduced.SERPINE1 was specifically expressed in the trophoblast,and its expression was higher in AMA women(P<0.05).Transfection of human SERPINE1(hSERPINE1)into HTR8-S/Vneo trophoblast cells showed fewer invading cells in the hSERPINE1 group.Impaired cell invasion may underlie the increased risk of adverse pregnancy outcomes in AMA women.Abnormal expression of SERPINE1 in extravillous trophoblast(EVT)cells appears to play an important role.

高龄孕妇雄激素水平与不良妊娠结局的关系

目的探讨高龄孕妇雄激素水平与不良妊娠结局的关系。方法选取2022年5-10月在常州市妇幼保健院收治入院待分娩的孕妇共192例作为研究对象。研究对象根据妊娠期高血压疾病诊治指南及孕妇年龄分为单纯高龄组、高龄并发妊娠期高血压疾病组、健康对照组、适龄并发妊娠期高血压疾病组。采用化学发光法检测各组血清5种雄激素[血清总睾酮(TT)、性激素结合球蛋白(SHBG)、游离睾酮指数(FTI)、硫酸脱氢表雄酮(DHEAS)和雄烯二酮(A2)]水平。结果与健康对照组比较,适龄并发妊娠期高血压疾病组TT、A2、FTI显著增高,SHBG显著降低;单纯高龄组DHEAS水平降低,差异有统计学意义(P<0.05)。Pearson相关性分析显示,TT与研究对象年龄呈负相关(P<0.05),与收缩压、舒张压和体重指数呈正相关(P<0.05),与子代性别、子代体重无相关性(P>0.05)。多因素Logistic回归分析,发现TT和体重指数为孕妇发生妊娠期高血压疾病的独立危险因素(P<0.05)。结论高龄孕妇雄激素水平与孕妇发生妊娠期高血压疾病有关。

高龄孕妇妊娠中期高甘油三脂血症对母儿妊娠不良结局的影响分析

目的探索高龄孕妇妊娠中期高甘油三酯(TG)血症与母儿不良妊娠结局的关系,以期为围产期保健提供参考。方法选择2021年10月—2022年3月在江苏某三甲医院建卡分娩的孕产妇1690例为研究对象,收集研究对象社会人口学资料、妊娠的临床资料、围产儿结局资料等。按照年龄,将研究对象分为高龄组(≥35岁)及非高龄组(<35岁),测定其孕中期的血脂水平[血清总胆固醇(TC)、TG、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)];按照TG水平将研究对象进一步细分为高龄高TG血症组、高龄非高TG血症组、非高龄高TG血症组、非高龄非高TG血症组,比较不同组别研究对象的母儿不良妊娠结局。结果高龄组与非高龄组孕妇在年龄、孕次、产次、孕前身体质量指数、分娩孕周方面比较,差异均有统计学意义(P<0.05);血脂水平方面,2组孕妇TG水平比较,差异有统计学意义(P<0.05)。高龄高TG血症、高龄非高TG血症、非高龄高TG血症、非高龄非高TG血症孕妇妊娠期高血压疾病发病率、剖宫产率、早产发生率、妊娠期糖尿病(GDM)发病率、娩出大于胎龄儿的发生率比较,差异均有统计学意义(P<0.05)。其中高龄高TG血症组GDM发病率最高,与非高龄的2组孕妇比较,差异均有统计学意义(P<0.008),且非高龄非高TG血症组孕妇GDM发病率低于非高龄高TG血症组(P<0.008);高龄组内2组孕妇娩出大于胎龄儿的发生率比较,差异有统计学意义(P<0.008),非高龄组内2组孕妇娩出大于胎龄儿的发生率比较,差异亦有统计学意义(P<0.008),均表现为高TG血症组孕妇的的发生率高于非高TG血症组。4组孕妇甲状腺疾病、产后出血及新生儿为小于胎龄儿、新生儿窒息发生率比较,差异均无统计学意义(P>0.05)。logistic回归分析结果显示:孕前身体质量指数(OR=1.104,95%CI:1.060~1.150)、孕期增加体质量(OR=0.925,95%CI:0.901~0.950)、孕中期TG水平(OR=1.244,95%CI:1.045~1.483)是GDM发生的影响因素;孕前身体质量指数(OR=1.225,95%CI:1.164~1.289)、孕期增加体质量(OR=1.085,95%CI:1.051~1.119)、孕中期TG水平(OR=1.292,95%CI:1.040~1.606)是大于胎龄儿发生的影响因素。结论高龄孕妇容易发生高TG血症,且高TG水平与孕妇发生GDM、大于胎龄儿等不良妊娠结局有关,因此应提倡女性适龄妊娠、孕前控制体质量,孕期要重视血脂水平,临床上也应加强对孕妇TG水平的监测及管理。

地屈孕酮联合固肾安胎丸治疗高龄二胎先兆流产临床效果

目的 探讨高龄二胎先兆流产采取地屈孕酮联合固肾安胎丸治疗的效果。方法 选取2022年1—12月本院收治的80例高龄二胎先兆流产患者,随机将其分为2组,对照组采用地屈孕酮治疗,研究组在此基础上加以固肾安胎丸治疗,比较两组保胎效果、治疗前后β-hCG、E2以及妊娠结局、药物不良反应。结果 研究组总有效率优于对照组(P<0.05)。治疗前血清β-hCG、E2无差异(P>0.05);治疗后研究组更高(P<0.05)。研究组不良妊娠率低于对照组(P<0.05)。不良反应发生率两组无差异(P>0.05)。结论 对于高龄二胎先兆流产患者,采取地屈孕酮联合固肾安胎丸治疗不仅效果显著,还可对患者激素水平、妊娠结局进行改善,同时该方案不良反应少,安全性高。

Effect of maternal age on pregnancy： a retrospective cohort study

Background In the last few decades,there has been a delay in first-time pregnancies,and the average age of women at the time of delivery has increased in many countries.Advanced maternal age is associated with adverse pregnancy outcomes.This study aimed to determine the present trends and pregnancy outcomes related to maternal age in China.Methods Data were collected from 39 hospitals in mainland of China.All deliveries were performed after 28 completed weeks of gestation and between January 1 and December 31,2011.In total,110 450 of 112 441 cases were included in the study.All enrolled cases were divided into 6 age groups with 5-year intervals.The x2 test or Fisher＇s exact test and unadjusted binary-Logistic regression were used for statistical analysis.Results The mean age at the time of delivery was 28.18±4.70 years （range,14-52 years）.The teenage group （15-19 years） had a higher risk than the 25-29-year old group for anemia （odds ratio （OR）,1.4）,preeclampsia （OR,1.6）,preterm birth （OR,2.1）,low birth weight neonates （OR,2.3）,and perinatal mortality （OR,3.6）.The 35-39-year old group and ≥40-year-old group had a higher risk than the 25-29-year-old group for leiomyoma （OR,4.2 vs.5.8）,pregestational diabetes （OR,2.2 vs.3.8）,chronic hypertension （OR,4.6 vs.6.5）,gestational diabetes （OR,2.6 vs.3.5）,preeclampsia （OR,2.5 vs.3.6）,premature delivery （OR,1.8 vs.2.4）,postpartum hemorrhage （OR,1.5 vs.1.7）,placenta previa （OR,2.7 vs.4.0）,placental abruption （OR,1.4 vs.2.5）,cesarean delivery （OR,2.1 vs.2.5）,macrosomia （OR,1.2 vs.1.2）,low birth weight neonates （OR,1.6 vs.2.3）,and perinatal mortality （OR,1.6 vs.3.7）.Conclusion Maternal and neonatal risks are higher during the teenage years and at an advanced maternal age; 20-30 years of age is the lowest risk period for pregnancy and delivery.

Seizure frequency and obstetric complications at advanced maternal age:a preliminary observational study in women with epilepsy

Background:Seizure control during pregnancy and obstetric outcomes are of important concerns for women with epilepsy(WWE)and their families.Advanced maternal age(≥35 years)shows a growing trend in the society with changes of lifestyle,which also occurs in diseased populations.The advanced maternal age is an independent factor for some unsatisfying obstetric outcomes.In this study we explored the seizure control and obstetric complications associated with advanced maternal age in WWE.Methods:This study was based on the epilepsy pregnancy registry at West China Hospital.Patients with epilepsy in this registry who were aged 35 or older when starting pregnancy were included in this study.Their basic demographics and detailed information on epilepsy management and obstetric issues in all trimesters and during 1-year follow-up after birth were documented and reviewed.Data were processed by IBM SPSS version 22.0.The demographic characteristics,seizure frequency,treatment change,obstetric complications,and outcomes were analyzed and compared.Results:Fifteen patients were included in this study,with an average age of 36.32±2.39 years at pregnancy,and 73.33%of them were primiparas.The change of seizure frequency during pregnancy was not in a clear pattern,but there was an increased incidence of tonic-clonic seizures during the mid-and last trimesters.More than 20%of the patients had obstetric complications throughout the trimesters,including vaginal bleeding,hypothyroidism,and pre-eclampsia.The pre-eclampsia seemed extraordinarily complicated with other conditions.However,none of the complications were related with malformations or poor outcome of babies after 1-year follow-up.Conclusion:Advanced maternal age combined with WWE is associated with frequent common obstetric complications.Future controlled studies with large sample sizes are needed to explore the related risks in comparison with other WWE and non-epileptic populations.

Advanced maternal age and adverse obstetrical and neonatal outcomes of singleton pregnancies

Objective:To assess the impact of advanced maternal age on pregnancy and childbirth outcomes of singleton pregnancies.Study design:We retrospectively assessed singleton pregnant mothers who gave birth at Khaleej-e-Fars Hospital in Bandar Abbas,Iran,from January 2020 to January 2022.Demographic and obstetrical factors include educational level,medical insurance,residency place,access to prenatal care facilities,number of prenatal care visits,smoking status,gestational age,parity,infertility,maternal comorbidities,preeclampsia,eclampsia,preterm birth,low birth weight(LBW),intrauterine growth restriction(IUGR),macrosomia,placenta abnormalities(previa/acreta),placenta abruption,chorioamnionitis,meconium fluid,fetal distress,methods of delivery,rate of cesarean section(CS),perineal lacerations,postpartum hemorrhage,childbirth injury,shoulder dystocia,congenital malformation,neonatal asphyxia,and unfavorable maternal and neonatal outcome were compared between two groups.The Chi-square test assessed the relationship between categorical factors and maternal age groups.The influence of advanced maternal age on the risk of unfavorable pregnancy outcomes was evaluated using bivariate and multivariate logistic regression.Results:Of 8354 singleton deliveries,22.2%belonged to advanced-age mothers.Advanced-age mothers had less education than those aged 20–34 years old.Chronic hypertension,cardiovascular disease,overt diabetes,and thyroid dysfunction were more prevalent among advanced-age mothers.Compared with mothers aged 20–34 years,mothers aged 35 years and higher had a significantly higher risk of gestational diabetes(aOR:3.18,95%CI:1.56–6.95),preeclampsia(aOR:2.91,95%CI:1.35–4.72),placenta abnormalities(aOR:1.09,95%CI:0.77–1.94),CS(aOR:3.16,95%CI:1.51–3.87),postpartum hemorrhage(aOR:1.94,95%CI:1.24–2.61),intensive care unit admission(aOR:1.36,95%CI:1.15–1.99),LBW(aOR:1.35,95%CI:0.97–2.96),preterm birth(aOR:2.36,95%CI:1.65–4.83),stillbirth(aOR:1.18,95%CI:1.01–3.16),and neonatal intensive care admission(aOR:2.09,95%CI:0.73–3.92).According to bivariate regression,the risk of meconium fluid was lower in advanced-age mothers;however,the result of multivariate logistic regression found no correlation between advanced age and the Incidence of meconium fluid.Conclusion:Advanced-age mothers are at increased risk of adverse pregnancy and childbirth outcomes,which persist even after adjusting for several potential confounders.

孕中期双胎妊娠孕妇血清甲胎蛋白、游离β人绒毛膜促性腺激素、游离雌三醇水平联合检测预测不良母婴结局的价值

目的:观察孕中期双胎妊娠孕妇血清甲胎蛋白、游离β人绒毛膜促性腺激素(F-β-hCG)、游离雌三醇(uE_(3))水平联合检测预测不良母婴结局的价值。方法:选取2020年1月至2022年6月定期于该院产检的90名孕中期双胎妊娠孕妇进行前瞻性研究,检测其血清甲胎蛋白、F-β-hCG、uE_(3)水平,并观察其不良母婴结局发生率,比较不同母婴结局孕中期双胎妊娠孕妇血清甲胎蛋白、F-β-hCG、uE_(3)水平,采用受试者工作特征曲线(ROC)分析孕中期双胎妊娠孕妇血清甲胎蛋白、F-β-hCG、uE_(3)水平预测不良母婴结局的价值。结果:90名双胎妊娠孕妇不良母婴结局发生率为35.56%(32/90)。不良母婴结局孕中期双胎妊娠孕妇血清甲胎蛋白、F-β-hCG水平高于良好母婴结局孕妇,血清uE_(3)水平低于良好母婴结局孕妇,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,孕中期双胎妊娠孕妇血清甲胎蛋白水平预测不良母婴结局具有一定的价值(AUC=0.724,P<0.05);单项血清F-β-hCG、uE_(3)水平预测不良母婴结局具有较低的价值(AUC=0.698、0.691,均P<0.05);三者联合预测不良母婴结局具有较高的价值(AUC=0.905,P<0.05),且高于各单项指标预测价值。结论:孕中期双胎妊娠孕妇血清甲胎蛋白、F-β-hCG、uE_(3)水平联合检测预测不良母婴结局具有较高的价值。

妊娠中期唐氏筛查在高龄孕妇产前诊断中必要性探讨

目的探讨唐氏筛查在高龄孕妇产前诊断中的意义。方法有产前诊断指征的高龄孕妇899人,孕中期17-24周行羊膜腔穿刺,取羊水检查胎儿染色体。结果发现染色体异常6例在146例唐氏综合症筛查阳性(即孕妇血清甲胎蛋白(AFP)和游离性雌三醇(uE3)以及游离人绒毛膜促性腺激素(-βhCG)三联指标检测,将三联指标测定值输入唐氏综合征风险计算软件,以1/270为高危切割值,≥1/270确定为唐氏综合征筛查阳性)的高龄孕妇中,发现染色体异常6例唐氏综合征发生率为4.11%(6/146),高龄孕妇中未行唐氏筛查人数750人次,染色体异常人数12人,唐氏综合征发生率0.67%(5/750)。结论对高龄孕妇行孕中期血清血液筛查胎儿唐氏综合征,其筛查效率高于孕中期未行血清血液筛查的高龄孕妇,建议对高龄孕妇行孕中期胎儿唐氏综合征产前筛查。

高龄孕妇胎儿颈项透明层增厚的临床价值研究

目的探讨高龄孕妇(≥35岁)产前超声诊断胎儿颈项透明层(NT)增厚的临床价值。方法查阅2015年7月—2016年12月于浙江省立同德医院行胎儿NT测定的1 053例单胎高龄孕妇的病历资料,以NT≥2.5 mm为截断点,选取其中经产前超声诊断胎儿NT增厚的51例高龄孕妇为NT增厚组,随机选取同期经产前超声诊断胎儿NT正常的204例高龄孕妇为NT正常组。比较两组异常妊娠结局、胎儿结构畸形、染色体畸形的发生情况。结果高龄孕妇胎儿NT增厚的发生率为4.84%(51/1 053)。NT正常组204例孕妇中因胎儿畸形而采取医疗性终止妊娠1例(引产后发现胎儿系水囊样淋巴瘤),胎死宫内1例,失访2例;NT增厚组51例孕妇中发现重大胎儿畸形而采取医疗性终止妊娠21例,胎死宫内5例,出生后发现胎儿水囊样淋巴瘤1例,失访1例。NT增厚的高龄孕妇异常妊娠发生率为54.0%(27/50),NT正常的高龄孕妇异常妊娠的发生率为1.0%(2/202),差异有统计学意义(χ~2=105.450,P<0.001)。NT正常组1例终止妊娠的胎儿系孕18+周B超发现水囊状淋巴瘤,随后行羊膜腔穿刺检查提示22号染色体结构异常,故采取医疗性终止妊娠;NT增厚组医疗性终止妊娠的21例胎儿中术前均经过羊膜腔穿刺和产前B超诊断,9例为染色体异常,12例胎儿有严重结构畸形(其中含染色体异常7例),9例水囊状淋巴瘤(其中含染色体异常2例)。NT增厚的高龄孕妇胎儿染色体异常发生率20.0%(9/45),NT正常的高龄孕妇胎儿染色体异常的发生率0.5%(1/202),差异有统计学意义(χ~2=101.589,P<0.05)。结论高龄孕妇胎儿NT增厚组异常妊娠、染色体异常发生率高于NT正常组,胎儿NT测定对于不良妊娠、染色体异常具有一定的预测价值。

孕期多元化健康教育对高龄二胎孕妇健康行为和母婴结局的影响

目的探讨孕期多元化健康教育对高龄二胎孕妇健康行为和母婴结局的影响。方法选择2017年8月至2018年12月在中山市博爱医院进行产检和分娩的600例高龄二胎孕妇作为研究对象,采用随机数表法将孕妇分为对照组和观察组,每组300例。从妊娠建档开始至妊娠第28周末,对照组接受常规健康教育,观察组在常规健康教育的基础上接受以孕期自我体质量管理指导、孕期瑜伽结合拉玛泽呼吸法实操为主的多元化健康教育,在预产期前14 d比较两组孕妇的健康行为,妊娠结束后调查孕妇妊娠疾病和母婴结局,并用GQOLI-74问卷调查孕妇的孕期生活质量。结果观察组和对照组孕妇的及时产检(88.7%vs 79.7%)、自我体质量管理(81.0%vs 72.0%)、孕期锻炼(76.3%vs 67.3%)比较,观察组明显高于对照组,差异均有统计学意义(P<0.05);观察组和对照组孕妇的妊娠糖尿病(16.0%vs 30.0%)、妊娠高血压(18.0%vs 25.0%)、难产(15.7%vs 32.7%)、死胎(3.7%vs 7.7%)、产后出血(1.7%vs 4.7%)、新生儿异常体质量(7.0%vs 13.3%)、新生儿窒息(2.7%vs 6.0%)比较,观察组明显低于对照组,差异均有统计学意义(P<0.05);观察组孕妇的自然分娩率为74.7%,明显高于对照组的57.3%,差异有统计学意义(P<0.05);观察组和对照组孕妇的GQOLI-74总得分[(129.1±10.4)分vs(121.4±9.7)分]、心理功能维度得分[(34.6±3.1)分vs(30.8±2.9)分]和社会维度得分[(38.7±2.9)分vs(35.1±2.6)分]比较,观察组明显高于对照组,差异均有统计学意义(P<0.05)。结论以孕期自我体质量管理指导和孕期的锻炼为主的孕期多元化健康教育可提高高龄二胎的孕妇健康行为,减少妊娠疾病和不良母婴结局的发生风险,提高自然分娩率和孕妇的生活质量。

心理干预与高龄孕妇妊娠结局的关系

目的探讨心理干预与高龄孕妇妊娠结局的关系。方法将在我院进行产检分娩的196例高龄初产孕妇随机分为观察组(n=98)和对照组(n=98),给予对照组常规护理,给予观察组孕妇心理干预,比较分析两组孕妇的干预前后的心理状况、妊娠结局和相关并发症的发生情况。结果观察组孕妇干预后SCL-90症状自评量表、阿森斯失眠量表评分均明显低于对照组(P<0.01);所有高龄初产孕妇分娩的新生儿均未出现死亡;观察组产妇的自然分娩率(70.41%)明显高于对照组(27.55%),差异具有统计学意义(χ2=21.562,P<0.01)。对照组产妇的剖宫产率(68.37%)明显高于观察组(27.55%),差异具有统计学意义(χ2=15.208,P<0.01)。观察组产妇的妊娠期高血压病、早产、产后出血、足月低体重儿等相关并发症的发生率均明显低于对照组,差异具有统计学意义(P<0.05)。结论心理干预能够有效地改善高龄孕妇的心理状况,从而改善高龄产妇的妊娠结局。

中药坤泰胶囊提高高龄女性不孕妊娠率的研究

目的探讨中药坤泰胶囊对高龄女性不孕妊娠率的影响。方法选取2016年3月—2018年2月期间收治的130例高龄女性不孕患者为研究对象,随机分为对照组和治疗组,每组65例,对照组给予克罗米芬治疗,治疗组患者在对照组的基础上实施中药坤泰胶囊治疗,观察并比较两组患者的卵泡成熟时间、子宫内膜厚度及容受性、性激素水平、排卵、妊娠情况以及不良反应等指标。结果治疗组的卵泡成熟时间和子宫内膜厚度均优于对照组,差异具有统计学意义(P<0.05)。治疗前,两组患者的PI、RI差异无统计学意义(P>0.05);治疗后,治疗组的PI、RI均优于对照组,差异具有统计学意义(P<0.05)。治疗前,两组患者的T、E2、LH及FSH水平差异无统计学意义(P>0.05);治疗后,治疗组患者的T和LH水平均低于对照组,且E2和FSH水平均高于对照组,差异具有统计学意义(P<0.05)。治疗组患者的排卵率和妊娠率均高于对照组,差异具有统计学意义(P<0.05)。治疗组患者的总不良反应低于对照组,差异具有统计学意义(P<0.05)。结论针对高龄女性不孕患者实施中药坤泰胶囊治疗,可有效增加子宫内膜厚度,改善子宫内膜的容受性,促进卵泡成熟,能有效调节性激素水平,促进排卵,提高妊娠率,降低不良反应的发生,值得临床上推广使用。

北京市海淀街道35岁以上高龄妇女妊娠结局分析

目的了解北京市海淀街道户籍35岁以上高龄妇女的妊娠情况及其对分娩的影响。方法回顾性分析198例35岁以上孕妇的妊娠合并症、并发症、分娩方式及新生儿结局情况,并与1691例35岁以下孕妇进行比较分析。结果观察组的妊娠期糖尿病、妊娠合并妇科肿瘤的发生率分别为8.1%和2.5%,要显著高于对照组的3.6%和0.9%(x^2值分别为9.072、4.541,均P<0.05)。观察组剖宫产率为70.2%,显著高于对照组的40.0%(x^2=65.736,P<0.05)。观察组新生儿出生体重中位数为3250 kg,低于对照组的3 370 kg(z=-2.127,P<0.05);早产儿为5.6%,高于对照组的2.5%(x^2=4.759,P<0.05)。结论 35岁以上孕妇的妊娠合并症和并发症明显增多,剖宫产率、早产率升高。因此应加强对高龄孕产妇的围产期保健管理,预防妊娠并发症及合并症,合理控制剖宫产率,确保母婴安全与健康。

经阴道分娩高龄二胎产妇产后个体化盆底功能康复方案的构建及应用

目的 探讨个体化盆底功能康复在高龄二胎产妇产后盆底功能障碍中的应用效果。方法 选取2020年1月至2021年12月收治的产后盆底功能障碍高龄二胎产妇80例,随机分为研究组和对照组,每组40例。对照组给予常规康复护理方案,研究组实施个体化盆底功能康复。干预前和干预6个月后,比较2组产妇盆底肌生理变化以及盆底功能影响问卷简表(PFIQ-7)和盆底功能障碍问卷(PFDI-20)评分的差异。结果 研究组Ⅰ类和Ⅱ类肌纤维肌力、电压、疲劳值明显优于对照组,研究组Ⅰ类肌纤维持续收缩压、持续时间和Ⅱ类肌纤维快速收缩压、收缩个数明显高于对照组,差异有统计学意义(P<0.05)。研究组PFIQ-7、PFDI-20评分明显低于对照组,子宫脱垂情况明显优于对照组,差异有统计学意义(P<0.05)。结论 个体化盆底功能康复方案可有效提升高龄二胎产妇盆底肌力,提高生活质量。