三孩政策后孕产妇妊娠特征、分娩方式和围生儿结局的临床研究

程贤鹦; 王园园; 张朋辉; 徐丽雅

doi:10.16766/j.cnki.issn.1674-4152.003424

三孩政策后孕产妇妊娠特征、分娩方式和围生儿结局的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.003424

1.
树兰(杭州)医院妇产科，浙江杭州 310022
2.
浙江中医药大学研究生院，浙江杭州 310053

基金项目:

杭州市拱墅区医药卫生科技计划项目 202208

杭州市卫生科技计划项目 20220020

浙江省中医药科技计划项目 2023ZL591

详细信息

通讯作者:
程贤鹦，E-mail：logancxy@tom.com

中图分类号: R714 R714.3
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出版历程
- 收稿日期: 2023-10-28
- 网络出版日期: 2024-05-27

Study on pregnancy characteristics, delivery modes, and perinatal outcomes of after three-child Policy

1.
Department of Obstetrics and Gynecology, Shulan (Hangzhou) Hospital, Hangzhou, Zhejiang 310022, China

摘要

摘要: 目的探讨三孩政策后妊娠特征、分娩方式和围生儿结局的变化。方法收集树兰(杭州)医院三孩政策前2020年1月—2021年6月1 049例产妇(对照组)和三孩政策后2022年4月—2023年9月725例产妇(研究组)的临床资料，比较2组人群结构、妊娠合并症、产科并发症、分娩方式和围生儿结局差异。结果研究组妊娠期糖尿病(18.76%，136例)、胎盘植入(1.93%，5例)、胎儿窘迫(9.79%，71例)、妊娠合并甲状腺功能减退(12.83%，93例)发生率高于对照组[14.68%(154例)、0.76%(8例)、3.53%(37例)、8.77%(92例)]，妊娠期肝内胆汁淤积症(1.24%，9例)、妊娠合并乙型病毒性肝炎(2.07%，15例)发生率低于对照组[2.67%(28例)、3.72%(39例)，P＜0.05];研究组阴道助产率大于对照组，瘢痕子宫经阴道分娩率小于对照组(P＜0.05);研究组初产妇与二孩产妇剖宫产率小于对照组，三孩产妇剖宫产率高于对照组(P＜0.05)。研究组非医学指征剖宫率及二孩和三孩产妇非医学指征剖宫率均高于对照组，初产妇非医学指征剖宫率均低于对照组(P＜0.05);研究组产后出血、产后贫血、低蛋白血症、巨大儿、新生儿窒息发生率均高于对照组(P＜0.05)。结论三孩政策后生育的主要人群仍以初产妇、二孩产妇为主，二孩高龄产妇更多见，部分合并症/并发症和围生儿不良结局增多。
- 三孩政策 /
- 妊娠合并症 /
- 产科并发症 /
- 分娩方式 /
- 围生儿结局
Abstract: Objective To examine changes in pregnancy characteristics, mode of delivery and perinatal outcomes following the three-child policy. Methods We retrospectively collected clinical data from 1 049 parturients from Shulan (Hangzhou) Hospital who gave birth between January 2020 and June 2021 (control group) before the three-child policy and 725 parturients who gave birth between April 2022 and September 2023 (study group) after the policy. We compared the demographics, pregnancy complications, obstetric complications, mode of delivery and perinatal outcomes of the two groups. Results The incidences of gestational diabetes mellitus (18.76%, 136 cases), placenta accreta (1.93%, 5 cases), fetal distress (9.79%, 71 cases), and pregnancy associated with hypothyroidism (12.83%, 93 cases) were significantly higher in the study group those in the control group [14.68% (154 cases), 0.76% (8 cases), 3.53% (37 cases), 8.77% (92 cases), P < 0.05]. The incidences of intrahepatic cholestasis of pregnancy (1.24%, 9 cases) and pregnancy combined with hepatitis B (2.07%, 15 cases) were significantly lower those in the control group [2.67% (28 cases), 3.72% (39 cases), P < 0.05]. The rate of vaginal assisted delivery in the study group was higher than that in the control group, whereas the rate of vaginal delivery in women with scarred uterus was lower than that in the control group (P < 0.05). The rates of caesarean section for first and second births in the study group were significantly lower than those in the control group, while the rate of caesarean section for third birth was significantly higher than that in the control group (P < 0.05). The non-medical indication cesarean section rate and the non-medical indication cesarean section rate for the second and third births in the study group were significantly higher than those in the control group, whereas the non-medical indication cesarean section rate for the first births was significantly lower those that in the control group (P < 0.05). The incidences of postpartum hemorrhage, postpartum anemia, hypoproteinemia, macrosomia and neonatal asphyxia were higher in the study group than in the control group (P < 0.05). Conclusion The main birth population after the implementation of the three-child policy remains first and second births, with a higher number of older second births. Some pregnancy complications, obstetric complications and adverse perinatal outcomes have increased.
- Three-child policy /
- Pregnancy complications /
- Obstetrical complications /
- Delivery methods /
- Perinatal outcomes

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表 1 2组产妇人群结构比较(x±s)

Table 1. Comparison of population structure between two groups of parturients (x±s)

项目	对照组(n=1 049)	研究组(n=725)	统计量	P值
年龄(x±s，岁)	31.16±4.60	31.05±4.37	0.773^a	0.439
年龄≥35岁[例(%)]	171(16.30)	129(17.79)	1.855^b	0.173
初产妇年龄(岁)	28.31±1.70	26.85±1.85	2.651^a	0.008
初产妇≥35岁[例(%)]	34(6.75)	13(3.60)	4.094^b	0.044
二孩产妇≥35岁[例(%)]	125(25.10)	102(31.57)	4.111^b	0.043
三孩产妇≥35岁[例(%)]	11(23.91)	11(32.35)	0.698^b	0.403
婚姻状态[例(%)]			0.686^b	0.408
已婚	1 036(98.76)	719(99.17)
未婚	13(1.24)	6(0.83)
文化程度[例(%)]			2.352^c	0.019
中学以下	108(10.30)	62(8.55)
高中/中专	194(18.49)	130(17.93)
大专	342(32.60)	206(28.41)
本科	374(35.65)	303(41.79)
研究生	31(2.96)	24(3.31)
孕次(x±s，次)	3.03±0.49	2.92±0.57	1.533^a	0.064
产次(x±s，次)	0.68±0.06	0.86±0.08	2.324^a	0.020
产妇构成[例(%)]			8.346^b	0.039
初产妇	504(48.04)	361(49.79)
二孩产妇	498(47.47)	323(44.55)
三孩产妇	46(4.39)	34(4.69)
四孩产妇	1(0.10)	7(0.97)
流产次数(x±s，次)	1.09±0.12	1.45±0.08	3.947^a	< 0.001
既往有剖宫产分娩史[例(%)]	245(44.95)	126(34.61)	9.657^b	0.002
辅助生殖[例(%)]	9(0.86)	5(0.68)	0.155^b	0.694
孕周(x±s，周)	39.04±1.36	38.98±1.09	1.519^a	0.129
孕期体质量增长(x±s，kg)	13.81±2.41	14.36±2.05	3.983^a	< 0.001
产时BMI(x±s)	26.77±1.92	28.88±1.22	3.082^a	0.001
新生儿出生体重(x±s，g)	3 327.63±426.39	3 338.73±407.91	0.817^a	0.410
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 2组产妇妊娠合并症、产科并发症比较[例(%)]

Table 2. Comparative analysis of pregnancy and obstetric complications between two groups of parturients [cases (%)]

项目	对照组(n=1 049)	研究组(n=725)	χ²值	P值
妊娠期高血压疾病	37(3.53)	32(4.41)	0.553	0.457
妊娠期糖尿病	154(14.68)	136(18.76)	5.213	0.022
前置胎盘	9(0.86)	5(0.69)	0.155	0.694
胎盘植入	8(0.76)	14(1.93)	4.779	0.029
胎盘早剥	13(1.24)	9(1.24)	0.000	0.097
羊水过多	15(1.43)	12(1.66)	0.145	0.703
羊水过少	43(4.10)	31(4.28)	0.034	0.855
胎儿宫内生长受限	6(0.57)	4(0.55)	0.071	0.790
妊娠期肝内胆汁淤积症	28(2.67)	9(1.24)	4.280	0.039
胎儿窘迫	37(3.53)	71(9.79)	29.440	＜0.001
胎膜早破	195(18.59)	117(16.14)	1.777	0.183
早产	52(4.96)	29(4.00)	0.901	0.342
双胎妊娠	3(0.29)	4(0.55)	0.243	0.622
B族链球菌筛查阳性	75(7.15)	64(8.83)	1.671	0.196
妊娠合并甲状腺功能减退	92(8.77)	93(12.83)	7.555	0.006
妊娠合并甲状腺功能亢进	5(0.48)	3(0.41)	0.028	0.868
妊娠合并肝功能异常	20(1.91)	9(1.24)	1.180	0.277
妊娠合并乙型病毒性肝炎	39(3.72)	15(2.07)	3.949	0.047

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表 3 2组产妇分娩方式比较[例(%)]

Table 3. Comparison of delivery modes between two groups of parturients [cases (%)]

项目	对照组(n=1 049)	研究组(n=725)	χ²值	P值
总分娩方式比较			0.047	0.828
阴道分娩	624(59.49)	435(60.00)
剖宫产分娩	425(40.51)	290(40.00)
阴道分娩间比较			9.025	0.011
直接阴道分娩	603(96.63)	418(96.09)
阴道助产	6(0.96)	13(2.99)
瘢痕子宫经阴道分娩	15(2.41)	4(0.92)
急产	32(5.13)	27(6.21)	0.567	0.451
剖宫产分娩间比较			0.800	0.371
直接剖宫产	354(83.29)	234(80.69)
阴道分娩中转剖宫产	71(16.71)	56(19.31)
部宫产指征比较			5.904	0.015
医学指征剖宫产	317(74.59)	192(66.21)
非医学指征剖宫产	108(25.41)	98(33.79)
初产妇剖宫数	213(42.26)	118(32.69)	8.163	0.004
初产妇非医学指征剖宫数	75(35.21)	29(24.57)	3.986	0.046
二孩产妇剖宫产数	220(44.17)	120(37.15)	3.985	0.046
二孩产妇非医学指征剖宫数	32(14.55)	60(60.00)	49.452	＜0.001
三孩产妇剖宫产数	12(28.26)	15(44.11)	6.215	0.013
三孩产妇非医学指征剖宫数	1(8.33)	9(60.00)	8.105	0.004

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表 4 2组产妇产后并发症比较[例(%)]

Table 4. Comparison of postpartum complications between two groups of parturients [cases (%)]

组别	例数	产后出血	产后贫血	低蛋白血症	产褥感染	产后尿潴留
对照组	1 049	20(1.91)	391(37.27)	9(0.86)	14(1.33)	34(3.24)
研究组	725	25(3.45)	315(43.45)	15(2.07)	9(1.24)	27(3.72)
χ²值		4.122	6.822	4.711	0.029	0.301
P值		0.042	0.009	0.030	0.865	0.583

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表 5 2组围生儿并发症比较[例(%)]

Table 5. Comparison of perinatal complications between the two groups [cases (%)]

组别	例数	巨大儿	低出生体重儿	新生儿窒息	新生儿畸形	死胎
对照组	1 049	46(4.39)	31(2.96)	16(1.53)	2(0.19)	1(0.10)
研究组	725	56(7.72)	14(1.93)	25(3.45)	1(0.14)	0
χ²值		8.820	1.819	7.022	0.104
P值		0.003	0.177	0.008	0.747	0.999^a
注：^a为采用Fisher精确检验。

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