高龄经产妇的妊娠结局分析及护理对策探讨
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摘要
目的分析高龄经产妇的病例特点和妊娠结局,探讨临床护理对策,为高龄经产妇妊娠管理提供指导依据。方法回顾性分析2016年1月—12月在北京大学第三医院产科分娩的所有经产妇临床资料,共1 469例,产妇年龄在22～54岁,平均年龄(34.3±3.4)岁,平均分娩年龄大于35岁。根据产妇年龄分成三组,分娩时年龄<35岁为非高龄组,共769例;年龄在35≤～<40岁之间的为高龄组,共608例;年龄≥40岁为超高龄组,共92例。比较三组产妇的妊娠期合并症及并发症、剖宫产率及围产儿结局情况。结果三组经产妇妊娠期糖尿病、产后出血、子宫肌瘤、瘢痕子宫及剖宫产的发生率随年龄增加而增长,组间差异均有统计学意义。三组经产妇妊娠期高血压疾病、胎膜早破、前置胎盘的发生率比较,差异均无统计学意义。三组围产儿的早产、巨大儿、新生儿窒息及死胎的发生率比较,差异均无统计学意义。结论高龄经产妇妊娠期糖尿病、产后出血、子宫肌瘤、瘢痕子宫及剖宫产的发生风险随年龄增加而增长,应加强高龄经产妇的孕前及孕期教育,加强孕期管理,保障母婴健康。
Objective To analyze the characteristics of the women aged 35 years or older and their pregnancy outcomes, to explore the clinical nursing strategies, and to provide guidance for the management of those women. Methods A total of 1496 cases with the clinical data of all the multiparous women were include in the retrospective analysis from the obstetrics of Peking University Third Hospital from January to December 2016. Their mean age was 34.3±3.4 years old, ranging from 22 to 45. The participants were divided into three groups according to their maternal age. There were 769, 608, and 92 cases for pregnancy at age less than 35, between 35 and 40, and 40 or older, respectively. We made a comparison in the incidences of gestational complications, cesarean section and other perinatal outcomes in the three groups. Results The incidences of gestational diabetes mellitus(GDM), postpartum hemorrhage, uterine myoma, scarred uterus and cesarean section in the three groups increased with age statistically significantly(P<0.05). There was no statistically significant difference in the incidences of hypertensive disorders of pregnancy, premature rupture of membranes, placenta previa, preterm labor, macrosomia, neonatal asphyxia, and stillbirth among the three groups(P>0.05). Conclusion For multiparous women aged 35 or older, the risk of GDM, postpartum hemorrhage, uterine myoma, scarred uterus and cesarean section increased with age. Health education and management before and during pregnancy should be enhanced to ensure maternal and newborn health.
Objective To analyze the characteristics of the women aged 35 years or older and their pregnancy outcomes, to explore the clinical nursing strategies, and to provide guidance for the management of those women. Methods A total of 1496 cases with the clinical data of all the multiparous women were include in the retrospective analysis from the obstetrics of Peking University Third Hospital from January to December 2016. Their mean age was 34.3±3.4 years old, ranging from 22 to 45. The participants were divided into three groups according to their maternal age. There were 769, 608, and 92 cases for pregnancy at age less than 35, between 35 and 40, and 40 or older, respectively. We made a comparison in the incidences of gestational complications, cesarean section and other perinatal outcomes in the three groups. Results The incidences of gestational diabetes mellitus(GDM), postpartum hemorrhage, uterine myoma, scarred uterus and cesarean section in the three groups increased with age statistically significantly(P<0.05). There was no statistically significant difference in the incidences of hypertensive disorders of pregnancy, premature rupture of membranes, placenta previa, preterm labor, macrosomia, neonatal asphyxia, and stillbirth among the three groups(P>0.05). Conclusion For multiparous women aged 35 or older, the risk of GDM, postpartum hemorrhage, uterine myoma, scarred uterus and cesarean section increased with age. Health education and management before and during pregnancy should be enhanced to ensure maternal and newborn health.
引文
1 余淑芳.187 例高龄产妇妊娠结局的临床分析.中华全科医学,2015,13:426-427,440.
2 周桂菊,王冬梅,孙黎.高龄经产妇妊娠的临床特征及对妊娠结局的影响.中国妇幼保健,2016,31:4971-4973.
3 沈铿,马丁.妇产科学.第3版,北京:人民卫生出版社,2015:73-154.
4 汪雪雁,张迅.高龄妇女的孕前与孕期保健.实用妇产科杂志,2013,29:7-9.
5 Waldenstrdm U,Vigdis A,Anne BVN,et al.Adverse pregnancy outcomes related to advanced maternal age compared with smoking and being overweight.J Am CollObstetGynecol,2014,123:104-112.
6 Zheng J,Xiao X,Zhang Q,et al.Maternal high-fat diet modulates hepatic glucose,lipid homeostasis and gene expression in the PPAR pathway in the early life of offspring.Int J MolSci,2014,15:14967-14983.
7 张方芳,徐永莲,刘兴会,等.产后出血原因及相关危险因素135例临床分析.实用妇产科杂志,2014,30:144-146.
8 Sheiner E,Sarid L,Levy A,et al.Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage:a population -based study.Matern Fetal Neonatal Med,2015,18:149-154.
9 颜建英,黄科华,刘青闽,等.产后出血危险因素及高危评分系统临床价值研究.中国实用妇科与产科杂志,2014,30:791-797.
10 谢幸,孔北华,段涛.妇产科学.第9版,北京:人民卫生出版社,2018:204.
11 朱逢佳.高龄经产妇妊娠及妊娠结局临床分析.浙江大学,2015.
12 刘铭,段涛.控制剖宫产率的有效措施.实用妇产科杂志,2015,31:243-245.
13 劳力,何小文,叶宁.佛山市禅城区 4545 例经产妇妊娠及分娩情况分析.中国妇幼卫生杂志,2017,8:71-74.
14 魏素梅,金莹,熊雯,等.前次剖宫产术对再次妊娠影响的临床评价.实用妇产科杂志,2017,33:619-622.
15 张新宇,张倩.454 例高龄孕产妇妊娠结局分析.中国妇幼保健,2013,28:5968-5970.
16 谢幸,苟文丽.妇产科学.第8版,北京:人民卫生出版社,2013:64-65.
17 Niessen K,Werner-Bierwisch T,Metzing S,et al.Motherhood at the Age of 35 and Over:The Risk of Advanced Maternal Age as Perceived by Women -a Literature Study.Z Geburtshilfe Neonatol,2017,221:111-121.
2 周桂菊,王冬梅,孙黎.高龄经产妇妊娠的临床特征及对妊娠结局的影响.中国妇幼保健,2016,31:4971-4973.
3 沈铿,马丁.妇产科学.第3版,北京:人民卫生出版社,2015:73-154.
4 汪雪雁,张迅.高龄妇女的孕前与孕期保健.实用妇产科杂志,2013,29:7-9.
5 Waldenstrdm U,Vigdis A,Anne BVN,et al.Adverse pregnancy outcomes related to advanced maternal age compared with smoking and being overweight.J Am CollObstetGynecol,2014,123:104-112.
6 Zheng J,Xiao X,Zhang Q,et al.Maternal high-fat diet modulates hepatic glucose,lipid homeostasis and gene expression in the PPAR pathway in the early life of offspring.Int J MolSci,2014,15:14967-14983.
7 张方芳,徐永莲,刘兴会,等.产后出血原因及相关危险因素135例临床分析.实用妇产科杂志,2014,30:144-146.
8 Sheiner E,Sarid L,Levy A,et al.Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage:a population -based study.Matern Fetal Neonatal Med,2015,18:149-154.
9 颜建英,黄科华,刘青闽,等.产后出血危险因素及高危评分系统临床价值研究.中国实用妇科与产科杂志,2014,30:791-797.
10 谢幸,孔北华,段涛.妇产科学.第9版,北京:人民卫生出版社,2018:204.
11 朱逢佳.高龄经产妇妊娠及妊娠结局临床分析.浙江大学,2015.
12 刘铭,段涛.控制剖宫产率的有效措施.实用妇产科杂志,2015,31:243-245.
13 劳力,何小文,叶宁.佛山市禅城区 4545 例经产妇妊娠及分娩情况分析.中国妇幼卫生杂志,2017,8:71-74.
14 魏素梅,金莹,熊雯,等.前次剖宫产术对再次妊娠影响的临床评价.实用妇产科杂志,2017,33:619-622.
15 张新宇,张倩.454 例高龄孕产妇妊娠结局分析.中国妇幼保健,2013,28:5968-5970.
16 谢幸,苟文丽.妇产科学.第8版,北京:人民卫生出版社,2013:64-65.
17 Niessen K,Werner-Bierwisch T,Metzing S,et al.Motherhood at the Age of 35 and Over:The Risk of Advanced Maternal Age as Perceived by Women -a Literature Study.Z Geburtshilfe Neonatol,2017,221:111-121.