摘要
目的探讨不同引产方式及时机对妊娠期糖尿病患者妊娠结局的影响及安全性。方法回顾性分析2016年6月至2018年12月期间在陕西省宝鸡市妇幼保健院妇产科分娩的188例妊娠期糖尿病患者,按不同的引产时机分为A组(n=64,38~39^+6周)、B组(n=68,40~40^+6周)和C组(n=56,41~41^+6周),按不同的引产方式分为人工破膜+缩宫素引产(n=125)和欣普贝生引产(n=63)。观察所有产妇的妊娠结局,并对产妇及新生儿的状况进行1个月的追踪随访。结果A组剖宫产率(31.25%)显著高于C组(7.14%),差异有统计学意义(χ^2=10.848,P<0.05),C组羊水过少显著高于A组,差异有统计学意义(χ^2=8.496,P<0.05),三组子痫前期、胎膜早破、产后出血量、产褥病、总产程比较,差异均无统计学意义(P>0.05)。C组巨大儿(28.57%)、胎儿宫内窘迫(25.00%)、新生儿窒息(12.50%)均显著高于A组,差异有统计学意义(χ^2=12.147、15.214、8.496,均P<0.05)。两种引产方式阴道分娩率、产后出血、总产程、剖宫产指征、新生儿随访期间并发症比较,差异均无统计学意义(均P>0.05)。结论对于妊娠期糖尿病孕妇,应做好孕期血糖控制,完善孕期管理,不应单纯根据孕周决定引产时机,应根据宫颈成熟程度及胎儿情况等适时选择引产时机和引产方式,有助于提高引产成功率并降低母婴并发症的发生率。
Objective To explore effect and safety of different induced labor modes and timing on pregnancy outcome of pregnant women with gestational diabetes mellitus(GDM).Methods The clinical data of 188pregnant women with GDM who delivered in Department of Gynecology and Obstetrics of Baoji Municipal Maternity and Child Health Hospital from June 2016to December 2018 were retrospectively analyzed.According to timing of induced labor,64pregnant women with 38~39^+6 weeks of gestational age were divided into group A,68pregnant women with 40~40^+6 weeks of gestational age were divided into group B and 56pregnant women with 41~41^+6 weeks of gestational age were divided into group C.According to different labor induction mode,125pregnant women were divided into artificial rupture of membrane plus oxytocin induction subgroup and 63pregnant women were divided into Simpson induction subgroup.The pregnancy outcomes of all parturients were observed,and the parturients and the newborns were followed up for one month.Results The rate of cesarean section in group A(31.25%)was significantly higher than that in group C(7.14%),the difference was statistically significant(χ^2=10.848,P<0.05),the rate of oligohydramnios in group C was significantly higher than that of group A,the difference was statistically significant(χ^2=8.496,P<0.05).There were no significant differences among the three groups in preeclampsia,premature rupture of fetal membranes,amount of postpartum hemorrhage,puerperalism and total labor process(all P>0.05).In group C,the rates of macrosomia(28.57%),fetal distress(25.00%)and neonatal asphyxia(12.50%)were significantly higher than those in group A,and the differences were statistically significant(χ^2=12.147,15.214and 8.496respectively,all P<0.05).There were no significant differences in vaginal delivery rate,amount of postpartum hemorrhage,total labor process,indications of cesarean section and incidence of neonatal complications during the follow-up between the two subgroups(all P>0.05).Conclusion For pregnant women with GDM,we should do a good job in control of gestational blood glucose,improve gestational management,shouldn't determine timing and mode of induction only according to the gestational age,but also according to maturation of the cervix and condition of the fetus,which will help to improve success rate of induced labor and reduce incidences of maternal and neonatal complications.
作者
谢玲娟
张雅丽
赵晶
XIE Lingjuan;ZHANG Yali;ZHAO Jing(Department of Obstetrics,Baoji Municipal Maternity and Child Health Hospital,Shaanxi Baoji 721000,China)
出处
《中国妇幼健康研究》
2020年第3期382-386,共5页
Chinese Journal of Woman and Child Health Research
关键词
妊娠期糖尿病
欣普贝生
缩宫素
引产
妊娠结局
gestational diabetes mellitus(GDM)
Simpson
oxytocin
induced labor
pregnancy outcome
作者简介
谢玲娟(1981-),女,主治医师,主要从事产科研究;通讯作者:赵晶,副主任医师。
