羊水粪染新生儿不良结局的影响因素分析

doi:10.3760/cma.j.issn.1007-1245.2024.12.009

摘要/Abstract

摘要：

目的　探讨阴道分娩初产妇羊水粪染对新生儿近期结局的影响和新生儿发生不良结局的影响因素。方法　本研究为回顾性研究。选取2022年2月1日至2023年1月31日在广州医科大学附属妇女儿童医疗中心足月单胎经阴道头位分娩的3 113位初产妇，使用倾向性评分匹配分为羊水清和羊水粪染两组进行新生儿近期结局比较，每组535例。羊水清组产妇年龄（31.12±4.17）岁，孕周（39.67±0.86）周，体重指数（25.88±2.91）kg/m²；羊水粪染组产妇年龄（29.61±3.10）岁，孕周（39.60±0.84）周，体重指数（25.69±2.77）kg/m²。再将羊水粪染的新生儿根据是否出现不良结局分成新生儿非不良结局组（423例）和新生儿不良结局组（268例）。进行临床基线资料的单因素分析和多因素logistic回归分析羊水粪染新生儿发生不良结局的影响因素。结果　羊水粪染组新生儿重症监护病房入住率高于羊水清组［6.2%（33/535）比1.1%（6/535）］（χ²=19.399，P<0.001）；羊水粪染新生儿不良结局发生风险与Ⅱ/Ⅲ类电子胎心监护、第一产程时间增长、羊水Ⅲ度粪染相关（OR=4.536，95%CI 2.818～7.301，P<0.001；OR=1.001，95%CI 1.000～1.002，P=0.014；OR=3.756，95%CI 2.112～6.680，P<0.001）。结论　初产妇羊水粪染会增加新生儿重症监护病房入住率，羊水粪染初产妇产程中出现Ⅱ/Ⅲ类电子胎心监护、羊水Ⅲ度粪染、第一产程时间增长会增加新生儿近期不良结局。

关键词:

新生儿, 羊水粪染, 初产妇, 阴道分娩, 电子胎心监护, 结局

Abstract:

Objective　To explore the impact of meconium-stained amniotic fluid on short-term outcomes in newborns delivered vaginally by primigravid women and analyze the influencing factors associated with neonatal adverse outcomes. Methods　A total of 3 113 primiparas delivered vaginally at term in singleton cephalic position in Guangzhou Women and Children's Medical Center of Guangzhou Medical University from February 1, 2022 to January 31, 2023 were included. The subjects were classified into two groups using propensity score matching: a normal amniotic fluid group (535 cases) and a meconium-stained amniotic fluid group (535 cases). In the normal amniotic fluid group, the maternal age was (31.12±4.17) years old, the gestational week was (39.67±0.86) weeks, and the body mass index was (25.88±2.91) kg/m². In the meconium-stained amniotic fluid group, the maternal age was (29.61±3.10) years old, the gestational week was (39.60±0.84) weeks, and the body mass index was (25.69±2.77) kg/m². According to whether the adverse outcomes were present, the newborns with meconium-stained amniotic fluid were further divided into a non-adverse outcome group (423 cases) and an adverse outcome group (268 cases). Univariate analysis was performed to analyze the clinical baseline characteristics, and multivariate logistic regression analysis were used to further explore the influencing factors of neonatal adverse outcomes. Results　Compared with the normal amniotic fluid group, the meconium-stained amniotic fluid group had a higher rate of admission to neonatal intensive care unit [6.2% (33/535) vs. 1.1% (6/535)] (χ²=19.399, P<0.001). The risk of neonatal adverse outcomes with meconium-stained amniotic fluid was associated with category Ⅱ/Ⅲ cardiocography, prolonged first stage of labor, and grade Ⅲ meconium staining (OR=4.536, 95%CI 2.818-7.301, P<0.001; OR=1.001, 95%CI 1.000-1.002, P=0.014; OR=3.756, 95%CI 2.112-6.680, P<0.001). Conclusions　Meconium-stained amniotic fluid in primiparas increases the rate of admission to neonatal intensive care unit for newborns; category Ⅱ/Ⅲcardiocography, grade Ⅲ meconium staining in amniotic fluid, and prolonged first stage of labor are associated with increased risk of short-term adverse outcomes in newborns.

Key words:

Newborns, Meconium-stained amniotic fluid, Primipara, Vaginal delivery, Cardiotocography, Neonatal outcomes

周蓓曾慧倩郑峥王乐乐颜凤赖毓冕.

羊水粪染新生儿不良结局的影响因素分析 [J]. 国际医药卫生导报, 2024, 30(12): 1977-1982.

Zhou Bei, Zeng Huiqian, Zheng Zheng, Wang Lele, Yan Feng, Lai Yumian.

Influencing factors of neonatal adverse outcomes with meconium-stained amniotic fluid [J]. International Medicine and Health Guidance News, 2024, 30(12): 1977-1982.

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