摘要： 目的 回顾性分析子痫前期孕妇经阴道试产的临床特征和分娩结局，探讨产时中转剖宫产的危险因素。方法 纳入子痫前期孕妇1 264例，根据分娩方式将其分为阴道分娩组（n=1 016）和中转剖宫产组（n=248），分析产时中转剖宫产的危险因素及其对分娩结局的影响。结果 1 264例孕妇中，产时中转剖宫产率为19.6%。单因素分析结果显示，中转剖宫产组的年龄、分娩孕周以及宫内感染、剖宫产史、臀位先露、妊娠合并子宫肌瘤、辅助生殖技术、分娩镇痛、人工破膜和催产素加强宫缩的比例均明显高于阴道分娩组（P < 0.05）。多因素logistics回归分析结果显示，年龄和辅助生殖技术（OR=1.077，95%CI：1.034~1.112，P < 0.01；OR=1.777，95%CI：1.025~3.079，P < 0.01）是产时中转剖宫产的危险因素。中转剖宫产组新生儿体质量和新生儿身长均明显大于阴道分娩组（P < 0.05），产后出血≥500 mL的发生率明显高于阴道分娩组（P < 0.05），而产后出血≥1 000 mL的发生率明显低于阴道分娩组（P < 0.05）。结论 年龄和辅助生殖技术是子痫前期孕妇产时中转剖宫产的独立危险因素，中转剖宫产时产后出血≥500 mL的发生率明显升高，但不增加产后出血≥1 000 mL和新生儿窒息的发生率。

子痫前期孕妇产时中转剖宫产的临床特征和危险因素

姜海利¹, 李金皎¹, 贾音², 王慧丽², 刘凯波³, 阴赪宏⁴

1. 首都医科大学附属北京妇产医院产科, 北京 100026;
2. 首都医科大学全科医学与继续教育学院, 北京 100069;
3. 首都医科大学附属北京妇产医院围产保健科, 北京 100026;
4. 首都医科大学附属北京妇产医院内科, 北京 100026

收稿日期:2021-02-26出版日期:2021-10-30发布日期:2021-10-11
通讯作者:阴赪宏E-mail:yinchh@ccmu.edu.cn
作者简介:姜海利(1980-),男,副主任医师,博士.
基金资助:国家重点研发计划（2016YFC1000101）；首都卫生发展科研专项项目（2018-2-2111）


关键词: 子痫前期, 中转剖宫产, 危险因素
Abstract: Objective To retrospectively analyze the clinical characteristics and delivery outcomes of women with preeclampsia and explore the risk factors of intrapartum cesarean section (ICS). Methods A total of 1 264 women with preeclampsia were enrolled in this study and assigned into the vaginal delivery (VD) (n=1 016) and ICS groups (n=248). The risk factors of ICS and delivery outcomes were analyzed. Results The ICS rate was 19.6%. In the univariate analysis, age, gestational age, and the proportions of intrauterine infection, history of cesarean section, breech, uterine fibroid, assisted reproductive technology, epidural analgesia, artificial rupture of membranes, and oxytocin augmentation during labor were significantly higher in the ICS group than in the VD group (P < 0.05). However, in the multivariate logistic regression analysis, only age and assisted reproductive technology (OR=1.077, 95% CI:1.034-1.112, P < 0.01;OR=1.777, 95% CI:1.025-3.079, P < 0.01) were the risk factors for ICS. The neonatal weight and length in the ICS group were significantly higher than those in the VD group (P < 0.05). Compared with the VD group, the rate of postpartum hemorrhage ≥ 500 mL and ≥ 1 000 mL was significantly higher and lower, respectively, in the ICS group (P < 0.05). Conclusion Age and assisted reproductive technology were the independent risk factors for ICS in women with preeclampsia. The rate of postpartum hemorrhage ≥ 500 mL significantly increased after ICS, but the rate of postpartum hemorrhage ≥ 1 000 mL and neonatal asphyxia did not.
Key words: preeclampsia, intrapartum cesarean section, risk factor
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