1 421例治疗性晚期早产的相关危险因素分析

doi:10.3877/cma.j.issn.1673-5250.2014.01.017

目的

探讨治疗性晚期早产的相关危险因素，降低晚期早产发生率。

方法

选择2001年1月至2011年6月于连云港市妇幼保健院就诊的1 421例治疗性晚期早产患者为研究对象，纳入研究组（n＝1 421）；并按照入院顺序随机抽取同期就诊的1 288例足月分娩产妇为对照组（n＝1 288）（本研究遵循的程序符合连云港市妇幼保健院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书）。应用单因素分析和多因素非条件logistic回归分析筛选晚期早产的相关危险因素。

结果

两组新生儿出生体质量、平均住院时间、新生儿期并发症发生率比较，差异有统计学意义（P<0.01），而两组死亡率比较，差异无统计学意义（P>0.05）。胎膜早破[OR ＝5.442, 95%CI（3.53~ 8.40）；P<0.001]、双胎[OR＝7.918, 95%CI（3.52～17.81）；P<0.001]、重度子痫前期[OR＝13.234 ，95 %CI （6.28~ 27.87）；P<0.001]与晚期早产密切相关。

结论

胎膜早破、双胎、重度子痫前期、前置胎盘及胎盘早剥是治疗性晚期早产的相关因素，其中，前三者是其独立危险因素。推行孕前咨询及产前检查，加强围生期管理，进行早产二级预防，开展对自发性早产的预测，可延长孕周，降低治疗性晚期早产发生率。

关键词: 晚期早产, 危险因素, logistic回归分析

Objective

To investigate the clinical factors associated with iatrogenic late preterm birth.

Methods

From January 2001 to June 2011, 1 421 women with late preterm birth in the Maternity and Child Hospital of Lianyungang were included in the study as research group (n=1 421) . Meanwhile 1 288 full-term pregnant women were randomly selected as control group (n =1 288) . Clinical factors associated with iatrogenic late preterm birth were selected by logistic regression analysis method to provide basis for establishing the system. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of the Maternity and Child Hospital of Lianyungang. Informed consent was obtained from each patients.

Results

There had significant differences between two groups in birth weight, hospital duration, neonatal complications (P<0.01) , and there was no significant difference in mortality rate between two groups (P>0.05) . Logistic regression analysis showed that premature rupture of membranes[OR=5.442, 95%CI(3.53-8.40) ; P<0.001], twin pregnancy[OR =7.918, 95% CI(3.52-17.81) ; P<0.001], preeclampsia[OR=13.234, 95 %CI(6.28-27.87) ; P<0.001], placenta and placenta abruption were related risk factors for iatrognic late preterm birth, among which premature rupture of membranes, twin pregnancy, preeclampsia were the independent risk factors.

Conclusions

Premature rupture of membranes, twin pregnancy, preeclampsia, placenta and placenta abruption were the risk factors associated with iatrognic late preterm birth. Implementing preconception counseling and inspection, strengthening the perinatal management, completing two levels of prevention and carrying prediction of spontaneous preterm labor can prolong the gestational age, lower the iatrognic late preterm birth rate.

Key words: Late preterm, Risk factors, Logistic regression

表1 治疗性晚期早产的单因素分析结果[n（％）]

Table 1 Univariate analysis results of risk factors of iatrogenic late preterm births [n（%）]

组别	n	疤痕子宫	双胎或多胎	胎盘早剥	前置胎盘	胎位不正	胎儿窘迫	FGR	羊水过少	妊娠期糖尿病	重度子痫前期	胎膜早破
研究组	1421	39(3.03)	18 (1.39)	8(0.62)	22(1.71)	51(3.96)	82(6.36)	145(11.26)	64(4.96)	10(0.78)	70(5.43)	120 (9.31)
对照组	1288	79(5.56)	187(13.16)	16(1.26)	65(4.57)	88(6.19)	31(2.18)	106 (7.46)	95(6.70)	13(0.91)	142(9.99)	216(15.20)
		10.39	20.77	18.19	17.84	6.92	25.43	11.59	3.62	38.62	19.46	16.24
P		0.006	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	0.057	0.154	<0.001	<0.001

表1 治疗性晚期早产的单因素分析结果[n（％）]

Table 1 Univariate analysis results of risk factors of iatrogenic late preterm births [n（%）]

组别	n	疤痕子宫	双胎或多胎	胎盘早剥	前置胎盘	胎位不正	胎儿窘迫	FGR	羊水过少	妊娠期糖尿病	重度子痫前期	胎膜早破
研究组	1421	39(3.03)	18 (1.39)	8(0.62)	22(1.71)	51(3.96)	82(6.36)	145(11.26)	64(4.96)	10(0.78)	70(5.43)	120 (9.31)
对照组	1288	79(5.56)	187(13.16)	16(1.26)	65(4.57)	88(6.19)	31(2.18)	106 (7.46)	95(6.70)	13(0.91)	142(9.99)	216(15.20)
		10.39	20.77	18.19	17.84	6.92	25.43	11.59	3.62	38.62	19.46	16.24
P		0.006	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	0.057	0.154	<0.001	<0.001

表2 治疗性晚期早产的多因素非条件logistic回归分析结果

Table 2 Results of logistic regression analysis of risk factors of iartrogenic late preterm births

危险因素	β	SE	Wald	P	OR	95% CI
胎盘早剥	2.474	1.149	4.631	18.190	11.864	1.25?112.89
前置胎盘	3.832	1.046	13.415	17.840	46.168	5.94~358.91
重度子痫前期	2.583	0.380	46.181	<0.001	13.234	6.28?27.87
胎膜早破	1.694	0.221	58.634	<0.001	5.442	3.53～ 8.40
双胎或多胎	2.069	0.414	25.022	<0.001	7.918	3.52~17.81

表2 治疗性晚期早产的多因素非条件logistic回归分析结果

Table 2 Results of logistic regression analysis of risk factors of iartrogenic late preterm births

危险因素	β	SE	Wald	P	OR	95% CI
胎盘早剥	2.474	1.149	4.631	18.190	11.864	1.25?112.89
前置胎盘	3.832	1.046	13.415	17.840	46.168	5.94~358.91
重度子痫前期	2.583	0.380	46.181	<0.001	13.234	6.28?27.87
胎膜早破	1.694	0.221	58.634	<0.001	5.442	3.53～ 8.40
双胎或多胎	2.069	0.414	25.022	<0.001	7.918	3.52~17.81

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Study on the Related Risk Factors of 1 421 Cases of Iatrogenic Late Preterm Birth

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Study on the Related Risk Factors of 1 421 Cases of Iatrogenic Late Preterm Birth