摘要
目的分析10年间早产率和经产率的变化,并初步探讨经产作为早产危险因素的可能性。方法本研究为队列研究,收集2013年1月至2022年12月于北京大学第一医院分娩的53979例产妇的一般临床资料及妊娠结局,回顾性分析10年间早产率及经产率的变化。采用单因素及多因素logistic回归分析,探讨自发性早产的危险因素及经产对妊娠结局的影响。结果(1)53979例产妇的总早产率为8.3%(4478/53979),早产率在10年间整体呈上升趋势,其中2017年、2018年早产率较高,分别为8.9%和9.2%。经产妇总占比为24.9%(13440/53979),呈先上升再下降后平稳趋势,2017年、2018年经产率最高,均为35.0%。(2)多因素logistic回归分析显示,经产是自发性早产的危险因素(OR=1.678,95%CI为1.523~1.850;P<0.001),也是妊娠34周前自发性早产的危险因素(OR=1.937,95%CI为1.632~2.301;P<0.001)。自发性早产的高危因素还包括多胎妊娠、妊娠期高血糖、羊水量异常、胎膜早破、宫内感染、子宫颈机能不全、子宫颈手术史、子宫发育异常(P均<0.05)。(3)与初产妇比较,经产妇的年龄较大、高龄占比较高、分娩孕周较早、早产率高、新生儿出生体重较高、多胎妊娠占比低;妊娠并发症或合并症中,妊娠期糖尿病、前置胎盘、胎盘植入、急产、巨大儿的发生率较高,妊娠期高血压、子痫前期、妊娠期肝内胆汁淤积症、羊水过少、胎儿生长受限、胎膜早破、宫内感染、产后出血的发生率较低;分别比较,差异均有统计学意义(P均<0.05)。结论近10年早产率整体呈上升趋势,早产高危因素与既往研究基本相似。经产妇是自发性早产的高危人群,且多种妊娠并发症和合并症风险升高,在孕期保健中应引起关注。
ObjectiveTo analyze the changes of preterm birth rate and proportion of multipara in 10 years,and to explore the possibility of multipara as a risk factor for preterm birth.MethodsThis study was a cohort study.The general clinical data and pregnancy outcomes of 53979 parturients delivered in Peking University First Hospital from January 2013 to December 2022 were collected,and the changes of preterm birth rate and proportion of multipara in the past 10 years were analyzed retrospectively.Single factor and multivariate logistic regression analysis were used to explore the risk factors of spontaneous preterm birth and the influence of multipara on pregnancy outcome.Results(1)The total preterm birth rate of 53979 parturients was 8.3%(4478/53979),and the overall preterm birth rate showed an upward trend in the past 10 years,among which the preterm birth rate was higher in 2017 and 2018,which were 8.9%and 9.2%respectively.The proportion of multipara was 24.9%(13440/53979),which showed a trend of rising first,then declining and then stabilizing.In 2017 and 2018,the proportion of multipara was the highest,accounting for 35.0%.(2)Multivariate logistic regression analysis showed that multipara was a risk factor for spontaneous preterm birth before 37 weeks of pregnancy(OR=1.678,95%CI:1.523-1.850;P<0.001),which was also a risk factor for spontaneous preterm birth before 34 weeks of pregnancy(OR=1.937,95%CI:1.632-2.301;P<0.001).The high risk factors of spontaneous preterm birth also include multiple pregnancies,hyperglycemia during pregnancy,abnormal amniotic fluid volume,premature rupture of membranes,intrauterine infection,cervical incompetence,history of cervical surgery and abnormal uterine development.(3)Compared with primiparas,multiparas was older,had earlier delivery weeks,higher premature delivery rate,higher birth weight and fewer multiple pregnancies.Among pregnancy complications,the incidence of gestational diabetes mellitus,placenta previa,placenta implantation,urgent delivery and macrosomia was higher,while th
作者
李贞娴
刘应南
秦胜堂
魏玉梅
Li Zhenxian;Liu Yingnan;Qin Shengtang;Wei Yumei(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China)
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2024年第9期682-691,共10页
Chinese Journal of Obstetrics and Gynecology
基金
国家重点研发计划(2022YFC2704605)。
关键词
早产
产次
危险因素
回顾性研究
Premature birth
Parity
Risk factors
Retrospective studies
