巨大儿产生相关危险因素分析及合理选择分娩方式

詹兵煌+尹丽群+叶玉娥

[摘要] 目的 探討巨大儿产生相关危险因素及不良妊娠结局和分娩方式选择。方法 选取2016年2～11月我院住院分娩足月单胎孕妇80例作为研究对象，根据新生儿出生体重将产妇分为巨大儿组（体重≥4000g）和非巨大儿组（体重<4000g），采用统计学软件对两组患者一般临床资料行单因素和多因素分析，探讨巨大儿发生相关危险因素，并比较两组患者不同分娩方式不同妊娠结局。结果 80例孕妇分娩后，32例新生儿体重≥4000g，占40.00%。单因素分析得出，巨大儿组患者孕周>40周、孕前及产前超重、文化程度低、妊娠期糖尿病、羊水过多占有比例显著高于非巨大儿组比较，差异有统计学意义（P<0.05）。多因素分析得出，孕周>40周、孕前超重、文化程度低、妊娠糖尿病为影响巨大儿产生相关危险因素。剖宫产分娩组中，巨大儿患者产后出血发生率高于非巨大儿组（P<0.05）；两组患者新生儿窒息、产褥感染及羊水粪染不良妊娠结局发生了比较，差异无统计学意义（P>0.05）；经阴道分娩组中，巨大儿组产后出血、难产、会阴裂伤不良妊娠结局发生率均高于非巨大儿组比较，差异有统计学意义（P<0.05）。结论 过期产、妊娠糖尿病、孕前超重、文化程度低均为巨大儿产生危险因素，临床中针对合并有相关危险因素孕妇应加强教育和干预，以降低巨大儿产生率，同时对合并有巨大儿产妇应进行综合评估，选择合理分娩方式，以确保分娩安全。

[关键词] 巨大儿；危险因素；分娩方式；不良妊娠结局

[中图分类号] R714.4 [文献标识码] A [文章编号] 2095-0616（2017）06-80-04

[Abstract] Objective To explore the risk factors of macrosomia， adverse pregnancy outcomes and delivery mode choice. Methods 80 cases with full term singleton pregnant women in our hospital from Feb. 2013 to Nov. 2016 were selected as objects， and were divided into macrosomia group （weight≥4000g） and non - macrosomia group （weight <4000g according to the neonatal birth weight. The risk factors of macrosomia were by single factor and multivariate analysis， and the different pregnancy outcome with different modes of delivery of two groups were compared. Results In 80 cases， 32 cases of newborn weight ≥4000g， accounted for 40.00%. Univariate analysis showed that gestation >40 weeks， pre pregnancy and prenatal overweight， low education level， gestational diabetes mellitus and over amniotic fluid rates of macrosomia group were higher than those of non-macrosomia group（P<0.05）. Multivariate analysis showed that： gestation >40 weeks， pre pregnancy overweight， low education level， gestational diabetes mellitus were risk factors of macrosomia. In cesarean delivery group， the incidence of postpartum hemorrhage in macrosomia group was higher than that in non-macrosomia group（P<0.05）. Neonatal asphyxia， puerperal infection and meconium stained amniotic fluid rates of two groups showed no significant difference（P>0.05）. In the vaginal delivery group， the postpartum hemorrhage， dystocia， perineal laceration rates of macrosomia group was significantly higher than those in the non-macrosomia group（P<0.05）. Conclusion Premature birth， gestational diabetes， pre pregnancy overweight， low education are risk factors of macrosomia. Pregnant women should be strengthened education and intervention in order to reduce the incidence of macrosomia. Meanwhile， comprehensive evaluation showed be made for maternal with macrosomia， and to choose reasonable delivery mode， to ensure delivery safety.

[Key words] Macrosomia； Risk factors；Delivery mode； Adverse pregnancy outcome

随着生活水平提高、生活习惯改变，巨大儿在临床中发病率呈逐年上升趋势，为临床中引起难产、产后出血、剖宫产主要因素[1]。巨大儿发生受多方面因素影响，与母体内营养过剩、妊娠合并症均有相关性，妊娠期间对合并有巨大儿产生危险因素孕妇进行积极干预，能有效降低巨大儿产生率，保障母婴安全[2]。本研究对巨大儿产生危险因素进行探讨分析，旨在为临床提供预防巨大儿产生危险因素，并分析其分娩方式，提高分娩安全，具体报道如下。

1 资料与方法

1.1 一般资料

选取2016年2～11月我院住院分娩足月单胎孕妇80例作为研究对象，年龄20～46岁，平均（29.4±5.6）岁；孕37～43周，平均（40.2±1.1）周。纳入标准：（1）所有产妇均为我院住院分娩患者；……