不同的妊娠间隔时间与高龄经产妇妊娠结局的关系  

The Relationship between Different Pregnancy Intervals and the Pregnancy Outcome of Elderly Multipara

作　　者：曾敏[1] 万瑶 李彬彬[1] 李军英[1] 徐敏娟[1] ZENG Min;WAN Yao;LI Binbin(Department of Obstetrics,Ganzhou People's Hospital,Ganzhou Jiangxi 341000.China;Department of Obstetrics,Ganzhou Kangli Hospital,Ganzhou Jiangxi 341000,China)

机构地区：[1]赣州市人民医院产科,江西贛州341000 [2]赣州市康俪医院产科,江两赣州341000

出　　处：《实用妇产科杂志》2022年第4期310-315,共6页Journal of Practical Obstetrics and Gynecology

基　　金：赣州市指导性科技计划项目(编号:GZ2019ZSF096)。

摘　　要：目的:探讨高龄经产妇不同妊娠间隔时间与妊娠结局(妊娠合并症、分娩并发症、新生儿窒息)的关系。方法:收集2019年1月至2020年6月在赣州市人民医院进行产前检查的高龄经产妇(其预产期年龄≥35岁) 205例作为研究对象。根据距上次妊娠间隔时间进行分组:A组(2~5年)97例、B组(6~9年) 63例、C组(≥10年) 45例。收集孕妇妊娠合并症、分娩方式、产程长短、分娩并发症、新生儿转科率及Apgar评分。比较各组妊娠结局的差异,以A组为对照,二分类Logistic回归分析评价妊娠间隔时间长短发生不同妊娠结局的风险。ROC曲线评估妊娠间隔时间预测发生不同妊娠结局的敏感性。结果:(1)A组、B组、C组经产妇的妊娠合并症、分娩并发症、第一产程时间、新生儿转科率和新生儿窒息程度整体上存在显著差异,A组不良妊娠结局的发生率最低,随妊娠间隔时间的延长,不良妊娠结局的发生率逐渐升高。(2)以A组作为参照,B组和C组发生妊娠期高血压、妊娠期糖尿病、胎膜早破、胎盘早剥、产后出血、羊水污染、新生儿窒息等结局的风险明显增加(P <0.05);加入年龄去除混杂因素后,与A组相比,B组发生胎膜早破(OR 2.35,95%CI 1.83~5.25,P=0.021)、胎盘早剥(OR 6.77,95%CI 3.46~12.73,P=0.000)的风险明显增加,C组发生妊娠期糖尿病(OR 3.86,95%CI 1.33~7.36,P=0.001)、胎膜早破(OR=6.92,95%CI 3.47~11.56,P=0.000),胎盘早剥(OR 12.88,95%CI 4.67~18.28,P=0.000)和新生儿窒息(OR4.82,95%CI 1.37~6.59、P=0.012)的风险显著增加。(3)ROC曲线表明,不同妊娠间隔时间预测发生妊娠期糖尿病、胎膜早破、胎盘早剥、新生儿窒息的敏感度分别为AUC=0.708,95%CI0.677~0.803;AUC=0.651,95%CI 0.556~0.683;AUC=0.606,95%CI 0.521~0.647;AUC=0.721,95%CI 0.681~0.788。结论:高龄孕妇发生不良妊娠结局的风险随着妊娠间隔时间的延长而逐渐增高。长妊娠间隔(6~9年、≥10年)是发生妊娠期糖尿病、胎�Objective: To explore the relationship between different pregnancy intervals and pregnancy outcomes( pregnancy comorbidities,delivery complications,neonatal asphyxia) in elderly multipara,with the goal of guiding them during the pregnancy time and preventing the occurrence of pregnancy complications and complications. Methods: A total of 205 cases of elderly multipara( the expected age of delivery ≥ 35 years old) who came to our hospital for obstetrics from January 2019 to June 2020 were collected as the research objects. 97 cases were in group A( 2-5 years),63 cases in group B( 6-9 years),and 45 cases in group C( ≥10 years)based on the time interval since the last pregnancy. Collect information from pregnant women on pregnancy complications,delivery methods,length of labor,delivery complications,neonatal transfer rate,and APGAR scores. To compare the differences in pregnancy outcome of each group,with group A as the control,the binary Logistic regression analysis was preformed to evaluate the risk of pregnancy interval to different pregnancy outcomes. The ROC curve was used for assessing the sensitivity of pregnancy intervals in terms of predicting the occurrence of various pregnancy outcomes. Results:(1) There were significant differences in the overall pregnancy complications,delivery complications,time of the first stage of labor,neonatal transfer rate,and neonatal asphyxia in groups A,B,and C. The incidence of bad pregnancy outcomes in Group A was the lowest. With the prolongation of the pregnancy interval,the incidence of adverse pregnancy outcomes gradually increases.(2)Taking group A as a reference,groups B and C exhibit significantly increased risks of gestational hypertension,gestational diabetes,premature rupture of membranes,premature abruption of placenta,postpartum hemorrhage,amniotic fluid contamination,and neonatal asphyxia( P < 0. 05);After adding age to remove confounding factors,compared with group A,premature rupture of membranes occurred in group B( OR 2. 35,95% CI 1. 83-5. 25,P = 0. 021)

关 键 词：妊娠间隔 高龄经产妇 妊娠结局 

分 类 号：R715.5[医药卫生—妇产科学]