摘要： 目的·探讨高龄初产妇的妊娠并发症和不良妊娠结局，总结高龄初产妇的妊娠特点。方法·选择2017年1月—2018年12月在广东医科大学附属顺德妇女儿童医院住院分娩的全部高龄初产妇共300例组成高龄初产妇组，将同期于该院分娩第2胎的全部高龄经产妇共2 138例组成高龄经产妇组，按照出院日期随机抽取2 088例适龄初产妇、1 839例分娩第2胎的适龄经产妇组成适龄初产妇组、适龄经产妇组。单因素分析采用
χ2检验和方差分析，多因素分析采用Logistic回归分析。比较分析4组产妇妊娠糖尿病、妊娠高血压、早产、产后出血等妊娠并发症和不良妊娠结局的差异。结果·以适龄经产妇组作为参照，通过多因素Logistic回归分析发现高龄初产妇组妊娠糖尿病（
aOR=2.938，95%
CI 2.240~3.853）、妊娠高血压（
aOR=8.579，95%
CI 3.082~23.887）、子痫（
aOR=6.139，95%
CI 2.400~15.985）、前置胎盘（
aOR=3.642，95%
CI 1.551~8.552）、羊水浑浊（
aOR=4.318，95%
CI 1.852~10.069）、早产（
aOR=2.573，95%
CI 1.710~3.871）、剖宫产（
aOR=2.589，95%
CI 1.988~3.373）、低出生体质量（
aOR=3.317，95%
CI 2.111~5.214）、新生儿窒息（
aOR=8.175，95%
CI 2.907~22.992）和呼吸窘迫综合征（
aOR=10.936，95%
CI 4.400~27.316）的发生风险最高。以适龄经产妇组作为参照，适龄初产妇组胎膜早破（
aOR=1.635，95%
CI 1.337~1.999）和羊水过多或过少（
aOR=1.730，95%
CI 1.317~2.271）的发生风险最高。以适龄经产妇组作为参照，高龄经产妇组发生盆腔粘连（
aOR=1.754，95%
CI 1.030~2.988）的风险最高，而适龄初产妇组发生盆腔粘连（
aOR=0.148，95%
CI 0.050~0.439）的风险最低。结论·高龄初产妇存在较高的妊娠糖尿病、妊娠高血压、子痫、前置胎盘、羊水浑浊、早产、剖宫产、低出生体质量、新生儿窒息和呼吸窘迫综合征风险。应重视高龄初产妇的围生期保健工作，使其接受规范化产前检查以提高其分娩质量。
关键词: 高龄, 初产妇, 经产妇, 妊娠并发症, 不良妊娠结局 Abstract: Objective·To explore the pregnancy complications and adverse pregnancy outcomes, and summarize the pregnancy characteristics of elderly primiparas.
Methods·A total of 300 elderly primiparas who delivered in Shunde Women's and Children's Hospital Affiliated to Guangdong Medical University from January 2017 to December 2018 were selected to form the elderly primipara group, and a total of 2 138 elderly multiparae who gave birth to their second child in the same period were selected to form the elderly multipara group. A total of 2 088 primiparas at the appropriate age were randomly selected according to the discharge date to form the appropriate age primipara group, and 1 839 multiparae at the appropriate age who gave birth to their second child were randomly selected to form the appropriate age multipara group. Univariate analysis was performed by χ2 test and analysis of variance, and multivariate analysis was performed by Logistic regression analysis. The differences among the four groups were compared and analyzed, including gestational diabetes mellitus, gestational hypertension, premature delivery, postpartum hemorrhage, and so on.
Results·Multivariate Logistic regression analysis showed that the elderly primiparas group had the highest risk of gestational diabetes mellitus (aOR=2.938, 95%CI 2.240?3.853), gestational hypertension (aOR=8.579, 95%CI 3.082?23.887), eclampsia (aOR=6.139, 95%CI 2.400?15.985), placenta previa (aOR=3.642; 95%CI 1.551?8.552), turbid amniotic fluid (aOR=4.318, 95%CI 1.852?10.069), premature delivery (aOR=2.573, 95%CI 1.710?3.871), cesarean section (aOR=2.589, 95%CI 1.988?3.373), low birth weight (aOR=3.317, 95%CI 2.111?5.214), neonatal asphyxia (aOR=8.175, 95%CI 2.907?22.992) and respiratory distress syndrome (aOR=10.936, 95%CI 4.400?27.316), compared with the appropriate age multiparae group. The appropriate age primipara group had highest risk of premature rupture of membranes (aOR=1.635, 95%CI 1.337?1.999) and hydramnios/oligohydramnios (aOR=1.730, 95%CI 1.317?2.271), compared with the appropriate age multipara group. The elderly multipara group had the highest risk of developing pelvic adhesions (aOR=1.754, 95%CI 1.030?2.988) compared with the appropriate age multipara group, whereas the appropriate age primipara group had the lowest risk of developing pelvic adhesions (aOR=0.148, 95%CI 0.050?0.439).
Conclusion·Elderly primiparas confer the highest risks of gestational diabetes mellitus, gestational hypertension, eclampsia, placenta previa, turbid amniotic fluid, premature delivery, cesarean section, low birth weight, neonatal asphyxia and respiratory distress syndrome. Attention should be paid to the perinatal care of elderly primiparas, so that they can receive standardized antenatal visits to improve the quality of their delivery.
Key words: advanced age, primipara, multipara, pregnancy complication, adverse pregnancy outcome PDF全文下载地址:
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