早期足月分娩的危险因素及新生儿并发症分析
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摘要
目的分析早期足月分娩的危险因素及新生儿并发症发生情况。方法回顾性分析本院2016年1月至2016年12月出生的735例足月活产新生儿的临床资料,按照胎龄将其分为早期组(早期足月儿,37～38周,280例)、完全组(完全足月儿,39～40周,395例)及晚期组(晚期足月儿,41～41~(+6)周,60例)。采用单因素及多因素Logistic回归分析探讨影响早期足月分娩的危险因素,并分析新生儿并发症发生情况。结果分娩次数> 1次、合并妊娠高血压综合征、合并妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)、胎膜早破及多胎妊娠均为早期足月分娩的独立危险因素(P_均<0.05)。早期组新生儿脑损伤、器官发育异常、低血糖的发生率均显著高于非早期组(P_均<0.05)。结论分娩次数> 1次、合并妊娠高血压综合征、合并ICP、胎膜早破及多胎妊娠的产妇易出现早期足月分娩,与非早期足月儿相比,早期足月儿脑损伤、低血糖及器官发育异常的发生率较高,应尽可能在围生期消除早期足月分娩的危险因素,并针对并发症,积极做好防治工作。
Objective To analyze the risk factors of early term delivery and neonatal complications. Method The clinical data of 735 term infants in our hospital from January 2016 to December 2016 were analyzed retrospectively, according to the gestational age,they were divided into early group(early term infants, 37 ～ 38 weeks, 280 cases), complete group(full term infants, 39 ～ 40 weeks,395 cases) and late group(late term infants, 41 ～ 41~(+6) weeks, 60 cases). Univariate and multivariate Logistic regression analysis were used to explore the risk factors of early term delivery and to analyze the neonatal complications. Result More than one delivery,complicated pregnancy-induced hypertension syndrome, complicated intrahepatic cholestasis of pregnancy(ICP), premature rupture of membranes and multiple fetation were independent risk factors for early term delivery(P_(all)< 0.05). The incidence of brain injury,organ dysplasia and hypoglycemia in early group was signi?cantly higher than that in non-early group(P_(all)< 0.05). Conclusion Parturients with more than one delivery, complicated pregnancy-induced hypertension syndrome, complicated ICP, premature rupture of membranes and multiple fetation are more likely to have early term delivery. Compared with non-early term infants, early term infants are more likely to have brain injury, hypoglycemia and organ dysplasia. The risk factors of early term delivery should be eliminated as far as possible in perinatal period, and the prevention and treatment of complications with high incidence should be done well.
Objective To analyze the risk factors of early term delivery and neonatal complications. Method The clinical data of 735 term infants in our hospital from January 2016 to December 2016 were analyzed retrospectively, according to the gestational age,they were divided into early group(early term infants, 37 ～ 38 weeks, 280 cases), complete group(full term infants, 39 ～ 40 weeks,395 cases) and late group(late term infants, 41 ～ 41~(+6) weeks, 60 cases). Univariate and multivariate Logistic regression analysis were used to explore the risk factors of early term delivery and to analyze the neonatal complications. Result More than one delivery,complicated pregnancy-induced hypertension syndrome, complicated intrahepatic cholestasis of pregnancy(ICP), premature rupture of membranes and multiple fetation were independent risk factors for early term delivery(P_(all)< 0.05). The incidence of brain injury,organ dysplasia and hypoglycemia in early group was signi?cantly higher than that in non-early group(P_(all)< 0.05). Conclusion Parturients with more than one delivery, complicated pregnancy-induced hypertension syndrome, complicated ICP, premature rupture of membranes and multiple fetation are more likely to have early term delivery. Compared with non-early term infants, early term infants are more likely to have brain injury, hypoglycemia and organ dysplasia. The risk factors of early term delivery should be eliminated as far as possible in perinatal period, and the prevention and treatment of complications with high incidence should be done well.
引文
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[15]Quigley MA,Poulsen G,Boyle E,et al.Early term and late preterm birth are associated with poorer school performance at age 5 years:a cohort study[J].Arch Dis Child Fetal Neonatal Ed,2012,97(3):F167-F173.
[16]钱晨,杨爱君.73例新生儿低血糖症的临床特点及危险因素分析[J].中国医刊,2016,51(12):100-103.
[17]杨璞玉,马彩虹,陈立雪,等.减少胚胎移植数量对高龄妇女体外受精-胚胎移植临床结局的影响[J].中华生殖与避孕杂志,2018,38(10):831-836.
[18]张洁,顾岚.某医院2015-2016年新生儿神经行为评分异常发生情况及影响因素分析[J].解放军预防医学杂志,2017,35(10):1252-1254.
[19]赵钰玮,刘光辉,余静,等.新生儿低血糖对学龄前期儿童气质及行为发育的影响[J].医学研究生学报,2017,30(8):844-848.
[2]龙莎莎,唐秋霞,黄冰雪,等.住院早期足月儿临床特征及近期结局影响因素分析[J].中华儿科杂志,2017,55(3):188-193.
[3]邢秋景,高亮,程慧清,等.晚期早产儿与早期足月儿剖宫产分娩高危因素及预后分析[J].中国妇幼保健,2015,30(36):6479-6482.
[4]Fleischman AR,Oinuma M,Clark SL.Rethinking the definition of "term pregnancy"[J].Obstet Gynecol,2010,116(1):136-139.
[5]高亮,程慧清,徐发林.早期足月儿围生期高危因素及并发症临床特征的研究[J].中华围产医学杂志,2016,19(3):212-218.
[6]陈洁,蒋艳纯,贾艳芳,等.早期足月儿的孕期因素和并发症分析[J].中国现代医学杂志,2018,28(1):120-124.
[7]Engle WA,Kominiarek MA.Late preterm infants,early term infants,and timing of elective deliveries[J].Clin Perinatol,2008,35(2):325-341.
[8]顾梦薇,孙丽洲.关于单独二胎政策出台的思考[J].南京医科大学学报(社会科学版),2014,14(2):109-111.
[9]Osterman MJ,Martin JA.Changes in cesarean delivery rates by gestational age:United States,1996-2011[J].NCHS Data Brief,2013(124):1-8.
[10]王金凤,陈升平.妊娠晚期胎膜早破孕妇宫颈分泌物培养与新生儿感染分析[J].中国医学前沿杂志(电子版),2016,8(9):120-123.
[11]田杰,丁志伟.早期足月产新生儿结局的探讨[J].中国医药导报,2015,12(18):71-74.
[12]付海波,徐静.不同胎龄足月儿临床转归研究[J].中国现代医学杂志,2018,28(6):114-117.
[13]Boyle EM,Poulsen G,Field DJ,et al.Effects of gestational age at birth on health outcomes at 3 and 5 years of age:population based cohort study[J].BMJ,2012,344:e896.
[14]Dong Y,Chen SJ,Yu JL.A systematic review and metaanalysis of long-term development of early term infants[J].Neonatology,2012,102(3):212-221.
[15]Quigley MA,Poulsen G,Boyle E,et al.Early term and late preterm birth are associated with poorer school performance at age 5 years:a cohort study[J].Arch Dis Child Fetal Neonatal Ed,2012,97(3):F167-F173.
[16]钱晨,杨爱君.73例新生儿低血糖症的临床特点及危险因素分析[J].中国医刊,2016,51(12):100-103.
[17]杨璞玉,马彩虹,陈立雪,等.减少胚胎移植数量对高龄妇女体外受精-胚胎移植临床结局的影响[J].中华生殖与避孕杂志,2018,38(10):831-836.
[18]张洁,顾岚.某医院2015-2016年新生儿神经行为评分异常发生情况及影响因素分析[J].解放军预防医学杂志,2017,35(10):1252-1254.
[19]赵钰玮,刘光辉,余静,等.新生儿低血糖对学龄前期儿童气质及行为发育的影响[J].医学研究生学报,2017,30(8):844-848.