333例巨大儿相关因素分娩方式及妊娠结局的研究
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摘要
目的:探讨巨大儿的相关因素、分娩方式与妊娠结局的关系。
方法:①对333例巨大儿的相关因素、分娩方式及妊娠结局进行回顾性分析,并随机选取335例同期住院分娩的正常新生儿作为对照组进行比较。②从巨大儿组中随机抽取28例高出生体重儿(LGA组)、从对照组中随机抽取30例正常出生体重儿(AGA组),采用免疫组织化学SABC法检测两组产妇胎盘组织中胰高血糖素样肽-1(GLP-1)和胰高血糖素样肽-1受体(GLP-1R)的表达水平。
结果:①巨大儿组新生儿的体重指数(BMI)、双顶径、股骨长、男婴数量高于对照组,差异有统计学意义(P<0.05)。②巨大儿组产妇的年龄、孕龄、产次、孕末期宫高、孕末期腹围、孕末期体重、孕末期羊水量、妊娠期糖尿病及过期妊娠率高于对照组,差异有统计学意义(P <0.05)。两组间孕次相比较,差异没有统计学意义(P >0.05)。③巨大儿组剖宫产率、持续性枕横位或枕后位、头盆不称、潜伏期延长、活跃期停滞、肩难产、宫缩乏力、会阴裂伤、胎膜早破、胎儿宫内窘迫、新生儿窒息、产后出血率高于对照组,差异有统计学意义(P<0.05)。④巨大儿组初产妇的剖宫产率高于经产妇,差异有统计学意义(P <0.05)。⑤巨大儿组孕周>41周者的剖宫产率高于孕周≤41周者,差异有统计学意义(P<0.05)。⑥新生儿体重(W)≥4250g组的剖宫产率大于新生儿体重4000g≤W<4100g组和新生儿体重4100g≤W<4250g组,差异有统计学意义(P<0.05)。新生儿体重4000g≤W<4100g组与新生儿体重4100g≤W<4250g组剖宫产率相比较,差异没有统计学意义(P>0.05)。⑦巨大儿组阴道分娩者胎儿宫内窘迫、新生儿窒息、新生儿产伤、产后出血率等母婴并发症高于剖宫产分娩者,差异有统计学意义(P<0.05);急症剖宫产分娩者胎儿宫内窘迫、新生儿窒息、产后出血率等母婴并发症高于择期剖宫产分娩者,差异有统计学意义(P<0.05);阴道分娩难产者胎儿宫内窘迫、新生儿窒息、新生儿产伤、产后出血率等母婴并发症高于阴道分娩顺产者,差异有统计学意义(P<0.05)。⑧LGA组胎盘组织中GLP-1、GLP-1R的表达水平低于AGA组,差异有统计学意义(P<0.05)。⑨胎盘组织中GLP-1、GLP-1R的表达水平与胎儿出生体重呈负相关(r =-0.454, P =0.023;r =-0.512, P=0.006)。
结论:①巨大儿的发生不仅与其母亲的年龄、孕龄、产次、孕末期宫高、孕末期腹围、孕末期体重、孕末期羊水量、妊娠期糖尿病率、过期妊娠率等因素密切相关,还和胎儿的性别密不可分。②胎盘组织中GLP-1、GLP-1R的表达水平可能在胎儿出生体重的调节中起重要作用。③分娩方式要根据胎儿体重、产次、孕周以及产妇的妊娠情况等综合因素进行评估选择。④定期对孕妇进行产前检查,根据妊娠情况指导孕妇合理膳食及运动,选择适宜的分娩方式、适当放宽剖宫产的手术指征、适时分娩、正确的处理产程,是早期预防和诊断巨大儿,降低母婴并发症的有效措施。
Objective: To investigate the relationship of related factors,delivery methods and pregnancy outcomes in fetal macrosomia.
Methods:①The clinical data of 333 cases of fetal macrosomia were enrolled in the study , and randomly selected 335 cases of pregnant women who delivered mature and normal weight fetus as control group.②Immunohistochemistry was used to measure glucagon-like peptide-1 and glucagon-like peptide-1 receptor levels in placenta from randomly selected 30 normal pregnant women(group AGA) in control group and randomly selected 28 women (group LGA) in fetal macrosomia group.
Results:①The body mass index (BMI), biparietal diameter, femur length and the number of baby boy in fetal macrosomia group were significantly higher than that in control group(P<0.05).②The maternal age, gestational age, parity, late pregnancy’s uterus height, abdominal circumference, bodyweight, amniotic fluid volume, the rate of gestational diabetes and expired pregnancy in fetal macrosomia group were significantly higher than that in control group(P<0.05). But the gravidity was no significant difference in two groups (P>0.05).③The rates of cesarean section, persistent occipito transverse position or posterior position, cephalopelvic disproportion, latency, protracted active phase, shoulder dystocia, uterine inertia, perineal laceration, premature rupture of membranes, fetal distress in uterus, neonatal asphyxia and postpartum hemorrhage in fetal macrosomia group were significantly higher than that in control group(P<0.05).④In comparison with the multiparas in fetal macrosomia, the primiparas in fetal macrosomia group showed increased rates of cesarean section(P<0.05).⑤In comparison with the less than 41 weeks gestational age’s maternal, the more than 41 weeks gestational age’s maternal in fetal macrosomias group showed increased rates of cesarean section(P<0.05).⑥In comparison with other two groups ,the rates of cesarean section were significantly higher in that group which birth weight is more than 4250g (P<0.05). In comparison with the group which birth weight is more than 4100g and less than 4250g, the rates of cesarean section in the group which birth weight is more than 4000g and less than 4100g were no significant difference(P>0.05).⑦In fetal macrosomia group, the incidence of fetal distress in uterus, neonatal asphyxia, birth trauma and postpartum hemorrhage were significantly elevated in vaginal delivery group in comparison with cesarean section group (P<0.05); the incidence of fetal distress in uterus, neonatal asphyxia and postpartum hemorrhage were significantly elevated in emergency cesarean section group in comparison with timely cesarean section group (P<0.05); the incidence of fetal distress in uterus, neonatal asphyxia, birth trauma and postpartum hemorrhage were significantly elevated in difficult vaginal delivery group in comparison with not difficult vaginal delivery group (P<0.05).⑧Glucagon-like peptide-1 and glucagon-like peptide-1 receptor levels in placenta in group LGA were significantly lower than that in group AGA(P<0.05).⑨Glucagon-like peptide-1 and glucagon-like peptide-1 receptor levels in placenta were negatively correlation with fetal birth weight (r=-0.454, P<0.05, r =-0.512, P<0.05).
Conclusion:①The incidence of fetal macrosomia not only with their mother’s age, gestational age, parity, late pregnancy’s uterus height, abdominal circumference, bodyweight, amniotic fluid volume, the rates of gestational diabetes and expired pregnancy, but also closely related to the sex of fetal.②Glucagon-like peptide-1 and glucagon-like peptide-1 receptor levels in placenta may be play an important role in controlling fetal growth weight.③The choice of delivery methods should be based on fetal weight, parity, gestational age and maternal conditions during the whole pregnancy.④Regular antenatal examination, pregnant women’s reasonable diets and movement in accordance with their pregnancy, select proper delivery methods, broadening indicatio of cesarean section, timely childbirth and correctly handle the delivery process are effective measures to early prevent and diagnose the fetal macrosomia and reduce the incidence of complications for both mothers and fetuses.
方法:①对333例巨大儿的相关因素、分娩方式及妊娠结局进行回顾性分析,并随机选取335例同期住院分娩的正常新生儿作为对照组进行比较。②从巨大儿组中随机抽取28例高出生体重儿(LGA组)、从对照组中随机抽取30例正常出生体重儿(AGA组),采用免疫组织化学SABC法检测两组产妇胎盘组织中胰高血糖素样肽-1(GLP-1)和胰高血糖素样肽-1受体(GLP-1R)的表达水平。
结果:①巨大儿组新生儿的体重指数(BMI)、双顶径、股骨长、男婴数量高于对照组,差异有统计学意义(P<0.05)。②巨大儿组产妇的年龄、孕龄、产次、孕末期宫高、孕末期腹围、孕末期体重、孕末期羊水量、妊娠期糖尿病及过期妊娠率高于对照组,差异有统计学意义(P <0.05)。两组间孕次相比较,差异没有统计学意义(P >0.05)。③巨大儿组剖宫产率、持续性枕横位或枕后位、头盆不称、潜伏期延长、活跃期停滞、肩难产、宫缩乏力、会阴裂伤、胎膜早破、胎儿宫内窘迫、新生儿窒息、产后出血率高于对照组,差异有统计学意义(P<0.05)。④巨大儿组初产妇的剖宫产率高于经产妇,差异有统计学意义(P <0.05)。⑤巨大儿组孕周>41周者的剖宫产率高于孕周≤41周者,差异有统计学意义(P<0.05)。⑥新生儿体重(W)≥4250g组的剖宫产率大于新生儿体重4000g≤W<4100g组和新生儿体重4100g≤W<4250g组,差异有统计学意义(P<0.05)。新生儿体重4000g≤W<4100g组与新生儿体重4100g≤W<4250g组剖宫产率相比较,差异没有统计学意义(P>0.05)。⑦巨大儿组阴道分娩者胎儿宫内窘迫、新生儿窒息、新生儿产伤、产后出血率等母婴并发症高于剖宫产分娩者,差异有统计学意义(P<0.05);急症剖宫产分娩者胎儿宫内窘迫、新生儿窒息、产后出血率等母婴并发症高于择期剖宫产分娩者,差异有统计学意义(P<0.05);阴道分娩难产者胎儿宫内窘迫、新生儿窒息、新生儿产伤、产后出血率等母婴并发症高于阴道分娩顺产者,差异有统计学意义(P<0.05)。⑧LGA组胎盘组织中GLP-1、GLP-1R的表达水平低于AGA组,差异有统计学意义(P<0.05)。⑨胎盘组织中GLP-1、GLP-1R的表达水平与胎儿出生体重呈负相关(r =-0.454, P =0.023;r =-0.512, P=0.006)。
结论:①巨大儿的发生不仅与其母亲的年龄、孕龄、产次、孕末期宫高、孕末期腹围、孕末期体重、孕末期羊水量、妊娠期糖尿病率、过期妊娠率等因素密切相关,还和胎儿的性别密不可分。②胎盘组织中GLP-1、GLP-1R的表达水平可能在胎儿出生体重的调节中起重要作用。③分娩方式要根据胎儿体重、产次、孕周以及产妇的妊娠情况等综合因素进行评估选择。④定期对孕妇进行产前检查,根据妊娠情况指导孕妇合理膳食及运动,选择适宜的分娩方式、适当放宽剖宫产的手术指征、适时分娩、正确的处理产程,是早期预防和诊断巨大儿,降低母婴并发症的有效措施。
Objective: To investigate the relationship of related factors,delivery methods and pregnancy outcomes in fetal macrosomia.
Methods:①The clinical data of 333 cases of fetal macrosomia were enrolled in the study , and randomly selected 335 cases of pregnant women who delivered mature and normal weight fetus as control group.②Immunohistochemistry was used to measure glucagon-like peptide-1 and glucagon-like peptide-1 receptor levels in placenta from randomly selected 30 normal pregnant women(group AGA) in control group and randomly selected 28 women (group LGA) in fetal macrosomia group.
Results:①The body mass index (BMI), biparietal diameter, femur length and the number of baby boy in fetal macrosomia group were significantly higher than that in control group(P<0.05).②The maternal age, gestational age, parity, late pregnancy’s uterus height, abdominal circumference, bodyweight, amniotic fluid volume, the rate of gestational diabetes and expired pregnancy in fetal macrosomia group were significantly higher than that in control group(P<0.05). But the gravidity was no significant difference in two groups (P>0.05).③The rates of cesarean section, persistent occipito transverse position or posterior position, cephalopelvic disproportion, latency, protracted active phase, shoulder dystocia, uterine inertia, perineal laceration, premature rupture of membranes, fetal distress in uterus, neonatal asphyxia and postpartum hemorrhage in fetal macrosomia group were significantly higher than that in control group(P<0.05).④In comparison with the multiparas in fetal macrosomia, the primiparas in fetal macrosomia group showed increased rates of cesarean section(P<0.05).⑤In comparison with the less than 41 weeks gestational age’s maternal, the more than 41 weeks gestational age’s maternal in fetal macrosomias group showed increased rates of cesarean section(P<0.05).⑥In comparison with other two groups ,the rates of cesarean section were significantly higher in that group which birth weight is more than 4250g (P<0.05). In comparison with the group which birth weight is more than 4100g and less than 4250g, the rates of cesarean section in the group which birth weight is more than 4000g and less than 4100g were no significant difference(P>0.05).⑦In fetal macrosomia group, the incidence of fetal distress in uterus, neonatal asphyxia, birth trauma and postpartum hemorrhage were significantly elevated in vaginal delivery group in comparison with cesarean section group (P<0.05); the incidence of fetal distress in uterus, neonatal asphyxia and postpartum hemorrhage were significantly elevated in emergency cesarean section group in comparison with timely cesarean section group (P<0.05); the incidence of fetal distress in uterus, neonatal asphyxia, birth trauma and postpartum hemorrhage were significantly elevated in difficult vaginal delivery group in comparison with not difficult vaginal delivery group (P<0.05).⑧Glucagon-like peptide-1 and glucagon-like peptide-1 receptor levels in placenta in group LGA were significantly lower than that in group AGA(P<0.05).⑨Glucagon-like peptide-1 and glucagon-like peptide-1 receptor levels in placenta were negatively correlation with fetal birth weight (r=-0.454, P<0.05, r =-0.512, P<0.05).
Conclusion:①The incidence of fetal macrosomia not only with their mother’s age, gestational age, parity, late pregnancy’s uterus height, abdominal circumference, bodyweight, amniotic fluid volume, the rates of gestational diabetes and expired pregnancy, but also closely related to the sex of fetal.②Glucagon-like peptide-1 and glucagon-like peptide-1 receptor levels in placenta may be play an important role in controlling fetal growth weight.③The choice of delivery methods should be based on fetal weight, parity, gestational age and maternal conditions during the whole pregnancy.④Regular antenatal examination, pregnant women’s reasonable diets and movement in accordance with their pregnancy, select proper delivery methods, broadening indicatio of cesarean section, timely childbirth and correctly handle the delivery process are effective measures to early prevent and diagnose the fetal macrosomia and reduce the incidence of complications for both mothers and fetuses.
引文
1.乐杰,主编.妇产科学[M].第7版.北京:人民卫生出版社, 2008:123-154.
2.Fuchs K, Gyamfi C. The influence of obstetric practices on late prematurity[J]. Clin Perinatol,2008, 35(2):343-360.
3.Boulet SL, Salihu HM, Alexander GR. Mode of delivery and the survival of macrosomic infants in the United States,1995-1999[J].Birth,2006,33(4):278-283.
4.王俊婷,王树松,顾春雷,等.巨大儿168例临床探讨[J].中国优生与遗传杂志,2010,8(18):86-93.
5.蔡中琼,叶海燕.非糖尿病性巨大儿发生的多因素分析[J].中国误诊学杂志,2006,6(9):1679～1680.
6.蔡兴苑,吴连方.巨大儿发生因素的研究进展[J].中外医疗,2008,14(95):116-118.
7.Jones RA, Okely AD, Gregory P, et al. Relationships between weight status and child, parent and community characteristics in preschool children[J]. Int J Pediatr Obes, 2009,4(1):54-60.
8.卜石,杨文英.胰升血糖素样肽-1与糖尿病治疗研究进展[J].国外医学内分泌学分册,2001,21(1):24-27.
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12.Halaska MG, Vik R, Feldmar P, et al. Predicting term birth weight using ultrasound and maternal characteristics[J]. Eur J Obstet Gynecol Reprod Biol,2006,128(1-2):231-235.
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14.Mocanu EV, Greene RA, Byrne BM, et al. Obstetric and neonatal outcome of babies weighing more than 4.5kg: an analysis by parity[J].Eur J Obstet Gynecol Reprod Biol,2000,92(2):229-233.
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20.陈春兰.巨大儿58例临床分析[J].基层医学论坛,2010, 9(14): 859-860.
1.郝淑芳,黄醒华.巨大胎儿相关因素研究进展[J].中国妇产科临床杂志,2004,5(3):230～232.
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4.蔡中琼,叶海燕.非糖尿病性巨大儿发生的多因素分析[J].中国误诊学杂志,2006,6(9):1679～1680.
5.Jones RA, Okely AD, Gregory P, et al. Relationships between weight status and child, parent and community characteristics in preschool children[J]. Int J Pediatr Obes, 2009,4(1):54-60.
6.Stotland NE, Caughey AB, Breed EM, et al. Risk factors and obstetric complications associated with macrosomia[J]. Int J Gynaecol Obstet, 2004,87(3):220～226.
7.Spellacy WN, Miller S, Winegar A, et al. Macrosomia--maternal characteristics and infant complications[J].Obstet Gynecol,1985,66(2):158-161.
8.乐杰,主编.妇产科学[M].第7版.北京:人民卫生出版社, 2008:123-154.
9.Fuchs K, Gyamfi C. The influence of obstetric practices on late prematurity[J]. Clin Perinatol,2008,35(2):343-360.
10.陈梅.巨大儿相关因素分析[J].当代护士,2009,4(44):65-66.
11.王晶,尚丽新,王树鹤,等.333例巨大儿分娩方式及妊娠结局的研究.中国优生与遗传杂志[J],2009,17(4): 67-128.
12.Halaska MG, Vik R, Feldmar P, et al. Predicting term birth weight using ultrasound and maternal characteristics[J]. Eur J Obstet Gynecol Reprod Biol,2006,128(1-2):231-235.
13.钱立杰,钱震宇.巨大胎儿预测研究进展[J].中国妇幼保健,2009,17(24):2450-2453.
14.蒋玮.巨大儿的母儿并发症及预防进展[J].中国民族民间医药, 2010,19(80):107-108.
15.王俊婷,王树松,顾春雷,等.巨大儿168例临床探讨[J].中国优生与遗传杂志, 2010,8(18):86-93.
16.蒋玮.巨大儿的母儿并发症及预防[J].首都医药,2008,12(32):27-28.
17.Mocanu EV, Greene RA, Byrne BM, et al. Obstetric and neonatal outcome of babies weighing more than 4.5kg: an analysis by parity[J].Eur J Obstet Gynecol Reprod Biol,2000,92(2):229-233.
18.Mathew M, Machado L, Al-Ghabshi R, et al.Fetal macrosomia. Risk factor and outcome[J]. Saudi Med J,2005,26(1):96-100.
19.黄蓉华,朱琳,辜小媚.巨大儿394例临床分析.中国实用医药[J],2009,20(4):50-51.
20.Henriksen T. Nutrition, weight and pregnancy[J]. Tidsskr Nor Laegeforen, 2007,127(18): 2399-2401.
21.陈跃,庞战军,刘青云.宫高腹围法预测巨大儿准确性的影响因素分析[J].中外医疗,2010,10(8):14-16.
22.陈春兰.巨大儿58例临床分析[J].基层医学论坛,2010, 9(14): 859-860.
2.Fuchs K, Gyamfi C. The influence of obstetric practices on late prematurity[J]. Clin Perinatol,2008, 35(2):343-360.
3.Boulet SL, Salihu HM, Alexander GR. Mode of delivery and the survival of macrosomic infants in the United States,1995-1999[J].Birth,2006,33(4):278-283.
4.王俊婷,王树松,顾春雷,等.巨大儿168例临床探讨[J].中国优生与遗传杂志,2010,8(18):86-93.
5.蔡中琼,叶海燕.非糖尿病性巨大儿发生的多因素分析[J].中国误诊学杂志,2006,6(9):1679～1680.
6.蔡兴苑,吴连方.巨大儿发生因素的研究进展[J].中外医疗,2008,14(95):116-118.
7.Jones RA, Okely AD, Gregory P, et al. Relationships between weight status and child, parent and community characteristics in preschool children[J]. Int J Pediatr Obes, 2009,4(1):54-60.
8.卜石,杨文英.胰升血糖素样肽-1与糖尿病治疗研究进展[J].国外医学内分泌学分册,2001,21(1):24-27.
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