摘要
研究背景近年来随着我国优生优育工作的深入开展,孕产妇及胎婴儿的健康倍受医务人员、广大患者及家属的关心。虽然我国早已执行计划生育的基本国策,但由于种种原因经产妇在产科临床中仍占一定比例,而且经产妇年龄偏大,本次分娩距前次分娩间隔时间较长,再次分娩新生儿体重明显增加,再孕巨大儿比例高于初产妇,经产妇中疤痕子宫所占比例越来越高,与20～30年前相比较有很大区别。但是无论是产妇本人还是产科医生对经产妇的分娩都存在着严重的麻痹思想。特别是近年来随着剖宫产技术的提高剖宫产率也在提高,而剖宫产率的增加一部分来自经产妇。文献报道经产妇剖宫产率逐年增高,已接近初产妇,因此探讨经产妇的分娩情况,分析经产妇难产原因、产时产后并发症及新生儿结局,对高危经产妇予以重视,避免母儿并发症发生,提高经产妇围产保健水平有着十分重要的意义。
目的通过回顾性分析经产妇一般情况、分娩方式、难产因素、产后并发症及新生儿结局,旨在提高对经产妇分娩的认识,重视经产妇妊娠期和分娩期管理,降低经产妇母儿并发症。
方法选取1999年3月至2009年2月我科收治的无内外科合并症的足月单胎经产妇共537例,对其一般情况、胎位情况、分娩方式、难产因素、妊娠合并症及并发症、新生儿结局进行回顾性分析。
结果1.经产妇的一般情况：537例经产妇年龄24-43岁,平均年龄31.50±3.96岁；孕次2-7次,平均2.78±0.51；产次2-5次,平均2.17±0.18次。
2.经产妇的胎位与分娩方式：537例经产妇中,头先露占94.97％；臀先露占4.66%；肩先露占0.37%。头先露经产妇中,自然分娩率83.53%；阴道手术助产率7.84%；剖宫产率8.63%。臀先露经产妇中,阴道分娩率36.00%；剖宫产率64.00%。肩先露均剖宫产分娩。
3.经产妇头先露难产因素如下：510例头先露经产妇中难产率16.47%。40例阴道助产经产妇中,难产因素如下：胎方位异常占50.00%；胎儿窘迫占25.00%；巨大儿占12.50%；子宫收缩乏力占12.50%。44例剖宫产经产妇手术指征如下：疤痕子宫占50.00%；胎儿窘迫占22.73%；巨大儿占13.64%；社会因素占11.3696；妊娠合并症占2.27％。
4.经产妇臀先露剖宫产指征：社会因素占62.5%；胎膜早破占18.75%；疤痕子宫占12.50%；巨大儿占6.25%
5.经产妇妊娠合并症及并发症分析：妊娠期高血压疾病占11.73%；产后出血占8.38%(其中子宫收缩乏力占62.22%,胎盘因素占35.56%,软产道裂伤占2.22%)；前置胎盘占3.72%；羊水过少占0.74%；羊水过多占0.56%。
6.新生儿结局分析：巨大儿占10.61%；低体重儿占1.86%；新生儿窒息占2.42%。
结论1.经产妇臀先露占4.66%,头先露经产妇自然分娩率85.53%,臀先露经产妇阴道分娩率36.00%。
2.经产妇头先露常见的难产因素为巨大儿、疤痕子宫、胎儿窘迫、胎方位异常、子宫收缩乏力、社会因素及妊娠合并症。
3.经产妇臀先露剖宫产指征中社会因素占第一位。
4.经产妇前置胎盘、妊娠期高血压疾病、产后出血发生率高。
5.经产妇巨大儿发生率增加,易引起难产和母婴并发症。
Background
In recent years, with the deep-going work of better natal and prenatal care and better upbringing, maternal and child health is being under the spotlight of medical staff, the majority of patients and their families. Though the basic national policy of family planning has been executed for a long time, multipara also takes a certain percentage in clinical obstetrics, wherever most multipara are older age, and the interval from the time of previous childbirth is long, newborn birth weight increased obviously. The proportion of having a macrosomia is higher than the primipara. And the proportion of uterine scar is more and more higher, which has a great different with that of 20 to 30 years ago. But neither multipara nor obstetrician take it serious on the delivery of multipara. Especially in recent years with the development of cesarean section technological, cesarean section rate is also improving. And part of that is from the multipara. The literatures reported that cesarean section rate increased year by year, which had been closed to the primipara. To investigate the delivery of multipara, analysis the reason of multipara dystocia and the complication of Intrapartum and Postnatal, and the result of the neonatal, pay more attention to the high risk of multipara, avoid the complication of maternal and child is very important to improve the level of health care of multipara.
Objective
By retrospective analysising the general situation, delivery mode, dystopia factors, postpartum complications and neonatal outcomes, this artical tried to improve the knowing of delivery of multipara, attach importance to the management of the multipara pregnancy and delivery, reduce the complication of maternal and child.
Methods
Choose 537cases full-time single births multipara without internal and surgical complications who are received and cured by our section during March,1999 to February,2009. Then to make a retrospective analysis of general situation, delivery mode, dystopia factors, postpartum complications and neonatal outcomes.
Results:
1. The general situation of multipara:the age of 537 cases multipara is between 24 to 43, the average age:31.50±3.96; the number of pregnancy:2-7, average number:2.78±0.51; the number of children:2-5, average number 2.17±0.18
2. Position of fetus and delivery mode:in 537 cases, head presentation is 94.97%; stern presentation is 4.66%; shoulder presentation is 0.37%. In the number of head presentation multipara:natural delivery rate is 83.53%; vaginal surgery rate is 7.84%; caesarean rate is 8.63%. In the number of stern presentation:vaginal surgery rate is 36.00%; caesarean rate is 64.00%. All of shoulder presentation is caesarean.
3. Dystopia factors of head presentation:In 510 cases, dystopia rate is 16.47%. Analysis the factor of 40 cases of dystopia vaginal surgery, abnormal fetal position is 50.00%; fetal distress is 25.00%; macrosomia is 12.50%; uterine atony is 12.50%; features of caesarean of multipara are:scared uterine is 50.00%, fetal distress is 22.73%; macrosomia is 13.64%, social factor is 11.36%, pregnant complications is 2.27%.
4. Features of multipara of head presentation:social factor is 62.5%, premature rupture of membrane is 18.75%, unscarred uterus is 12.50%, macrosomia is 6.25%,
5. Analysis on complication of pregacy and complication:gestational hypertension is 11.73%, postpartum hemorrhage is 8.38%(Among them 45.28% is uterine atony, Placental factor is 35.56%, soft birth canal laceration is 2.22%); placenta previa is 3.72%, oligohydramnios is 0.74%, hydramnios is 0.56%.
6. Neonatal outcome analysis:macrosomia is 10.61%, infant of low-birth weight is 1.86%, neonatal asphyxia is 2.24%
Conclusion
1. Stern presentation of multipara is 4.66%, head presentation of multipara spontaneous labor is 85.53%, vaginaldelivery rate of stern presentation multipara is 36.00%.
2. Dystopia factors of head presentation multipara are macrosomia, scared uterine, fetal distress, abnormal fetal position, uterine atony, social factor and pregnant complications.
3. Social factor is the chiefly feature of stern presentation of caesarean of multipara.
4. The rate of placenta previa, gestational hypertension and postpartum hemorrhage is high in multipara.
5. The rate of macrosomia increased, which will lead to dystopia and the complications of the maternal and child.
引文
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