摘要
目的观察胎儿体质量估计对初产妇巨大儿的分娩方式和围产结局的影响。方法选取2022年1月至2023年12月北京市海淀区妇幼保健院分娩的足月单胎初产妇206例,根据估计体质量分为甲组(估计胎儿体质量<4000 g,118例)和乙组(估计胎儿体质量≥4000 g,88例)。比较两组产妇及新生儿的分娩方式和分娩结局等。结果206例初产妇年龄21~39岁,平均(30.6±3.4)岁。与乙组相比,甲组阴道分娩比例较高(61.9%比40.9%)、剖宫产比例较低(32.2%比56.8%),两组分娩方式的差异有统计学意义(P<0.05)。甲组试产率明显高于乙组(90.7%比59.1%),差异有统计学意义(P<0.05)。甲组产后出血量(容积法)和校正产后出血量均高于乙组[350(300,500)ml比300(300,380)ml,440(230,720)ml比360(160,560)ml],差异有统计学意义(P<0.05)。两组胎儿窘迫、肩难产、新生儿窒息比例的差异无统计学意义(P>0.05)。结论低估胎儿体质量可增加初产妇巨大儿试产率及阴道分娩率,也增加了产后出血量,但并未增加胎儿窘迫、肩难产、新生儿窒息等分娩并发症。建议胎儿估计体质量<4500 g且有阴道分娩意愿的产妇,应该在充分告知的情况下,增加试产机会。
Objective To observe the influence of fetal weight estimation on delivery mode and perinatal outcome of primipara with macrosomia.Methods A total of 206 full-term singleton primiparas delivered in Haidian Maternal and Child Health Hospital from January 2022 to December 2023 were selected,and were divided into group A(estimated fetal weight<4000 g,118 cases)and group B(estimated fetal weight≥4000 g,88 cases)according to the estimated fetal weight.The delivery mode and delivery outcome of the two groups were compared.Results Among the 206 primiparas,the age ranged from 21 to 39 years,with an average age of(30.6±3.4)years.Compared with group B,the proportion of vaginal delivery in group A was higher(61.9%vs.40.9%),and the proportion of cesarean section was lower(32.2%vs.56.8%),the differences of delivery modes between the two groups were statistically significant(P<0.05).The trial production rate of group A was significantly higher than that of group B(90.7%vs.59.1%),and the difference was statistically significant(P<0.05).The postpartum hemorrhage volume(volumetric method)and corrected postpartum hemorrhage volume in group A were higher than those in group B[350(300,500)ml vs.300(300,380)ml,440(230,720)ml vs.360(160,560)ml],and the differences were statistically significant(P<0.05).There were no significant differences in the proportion of fetal distress,shoulder dystocia and neonatal asphyxia between the two groups(all P>0.05).Conclusions For primiparous with macrosomia,underestimated the fetal weight can increase the trial delivery rate and vaginal delivery rate,and also increase the postpartum hemorrhage,but does not increase the delivery complications such as fetal distress,shoulder dystocia,neonatal asphyxia.It is suggested that pregnant women whose estimated fetal weight is less than 4500 g and willing to give birth through vagina should increase the opportunity of trial delivery with full notification.
作者
陈磊
杨明芳
Chen Lei;Yang Mingfang(Department of Obstetrics,Haidian Maternal and Child Health Hospital,Beijing 100080,China)
出处
《北京医学》
CAS
2024年第3期222-225,共4页
Beijing Medical Journal
基金
海淀区属卫生健康系统高层次人才发展计划(2022HDXD006)。
关键词
巨大儿
胎儿体质量估计
阴道分娩
剖宫产
母婴结局
围产期
macrosomia
fetal weight estimation
vaginal delivery
cesarean section
maternal and infant outcome
perinatal period
