择期再次剖宫产终止妊娠的时机及母儿结局  

Timing of elective repeat cesarean delivery and maternal and neonatal outcomes

作　　者：刘洪莉[1] 漆洪波[1] 罗欣[1] 于德龙[1] 

机构地区：[1]重庆医科大学附属第一医院妇产科,400016

出　　处：《中华围产医学杂志》2014年第4期224-229,共6页Chinese Journal of Perinatal Medicine

基　　金：基金项目：国家自然科学基金（81170585、81300509）

摘　　要：目的 分析不同孕周行择期再次剖宫产的母儿围产期结局,探讨再次剖宫产的最佳终止妊娠时机. 方法 回顾性收集重庆医科大学附属第一医院（简称本院）产科电子病历系统记录的自2011年6月1日至2013年6月30日住院分娩的所有产妇资料.选择妊娠满37周且无合并症的单胎、行择期再次剖宫产的产妇为研究对象,根据孕周不同进行分组.采用单因素方差分析或x2检验,比较不同孕周终止妊娠的孕产妇的一般情况和妊娠结局以及新生儿不良事件的发生情况. 结果 共579例足月行再次剖宫产的产妇纳入本研究,其中妊娠39周前手术与39～周手术的比例分别为64.6％（374/579,其中37～周分娩者93例,38～周分娩者281例）和29.0％（168/579）,无孕产妇、胎儿或新生儿死亡.妊娠37～周、38～周、39～周、40～周和≥41周分娩的产妇2次剖宫产间隔时间差异无统计学意义（P＞0.05）,住院时间差异有统计学意义[分别为（4.9±3.0）、（4.3±1.3）、（4.3±1.0）、（4.5±1.2）和（4.0±0.7）d,F=2.849,P＜0.05].不同孕周分娩的产妇终止妊娠时体重指数、胎盘胎膜残留、术中术后出血、胎膜早破、转重症监护病房和子宫切除等情况差异均无统计学意义（P值均＞0.05）.5组分娩新生儿的出生体重和出生身长差异均有统计学意义[体重：（3 082.9±479.2）、（3 318.1±390.8）、（3 415.7±431.1）、（3 630.5±475.2）和（3 334.0±242.5）g,F=13.798;身长：（48.8±1.5）、（49.3±1.5）、（49.6±1.5）、（50.0±1.5）和（47.8±3.9）cm,F=7.460;P值均＜0.05],1 min和5 minApgar评分差异亦有统计学意义[1 min：（9.7±0.7）、（9.8±0.6）、（9.8±0.4）、（9.7±0.5）和（8.8±2.7）分,F=4.432;5 min：（9.9±0.3）、（10.0±0.3）、（10.0±0.2）、（10.0±0.2）和（9.2±1.8）分,F=9.625;P值均＜0.05].5组新生儿不良事件发生率包括转新生儿重症监护病房（neonatal intensive care uniObjective To explore the optimal timing of termination of pregnancy,we analyzed the different gestational age in repeat cesarean delivery and maternal and neonatal outcomes.Methods This was a retrospective study.The information of cesarean sections was collected from maternal obstetric records in the electronic medical recording system of the First Affiliated Hospital of Chongqing Medical University from June 1,2011 to June 30,2013,and women with intrauterine viable singleton pregnancies delivered after 37 weeks of gestation without prenatal complications were selected.They were divided into five groups with different gestational weeks.Maternal general information,perioperative outcome and rate of neonatal adverse event were analyzed with one way ANOVA analysis and Chi-square test.Results A total of 579 cases of elective repeat cesarean at term were performed.The ratios of cesarean section prior to 39 and 39-39＋6 weeks of gestation were 64.6% （374/579） and 29.0% （168/579）,respectively.No fetal,neonatal or maternal death occurred.There were no statistically significant differences in the termination of pregnancy at 37-37＋6 weeks,38 38＋6 weeks,39-39＋6 weeks,40 weeks and ≥ 41 weeks between the two time intervals for cesarean section （P〉0.05）.There were statistically significant differences in the length of hospitalization [（4.9±3.0）,（4.3 ± 1.3）,（4.3 ± 1.0）,（4.5± 1.2） and （4.0±0.7） d,respectively; F=2.849,P〈0.05].No significant difference was observed in the maternal BMI,placental membrane residue,maternal perioperative bleeding,premature rupture of membrane （PROM）,intensive care unit （ICU） admission and uterine resection （P〉0.05）.There were statistically significant differences among the five groups in neonatal weight [（3 082.9±479.2）,（3 318.1 ±390.8）,（3 415.7±431.1）,（3 630.5±475.2） and （3 334.0±242.5） g,F=13.798] and length [（48.8± 1.5）,（49.3± 1.5）,（49.6± 1.5）,（50.0± 1.5） and （47.8±3.9） cm,F=7.460; bot

关 键 词：剖宫产术 再 妊娠结局 

分 类 号：R719.8[医药卫生—妇产科学]