Analysis of risk factors related to extremely and very preterm birth: a retrospective study.
Analysis of risk factors related to extremely and very preterm birth: a retrospective study.
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极早产和极早产相关危险因素分析：一项回顾性研究
DOI：
10.1186/s12884-022-05119-7
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发表时间：
2022-11-05
影响因子：
3.1
通讯作者：
中科院分区：
文献类型：
--
作者：
早产是围产儿发病和死亡的主要原因之一，给家庭和社会带来了沉重的负担。本研究的目的是找出危险因素，分析临床上极早产(EP)和极早产(VP)胎龄为32周的极早产(EP)和极早产(VP)新生儿的出生情况和并发症，以进一步延长妊娠期。采用回顾性队列研究方法，收集南京医科大学附属妇产科医院2016-2020年收治的1,598例孕妇和1,660例早产儿(不包括229例因严重疾病和遗弃而死亡的早产儿)的资料。我们分别用t检验和卡方检验对连续变量和类别变量的妇女和新生儿的特征进行了比较。用多因素Logistic回归分析危险因素对EP和VP出生的影响。我们确定了EP出生的3个独立危险因素：宫颈功能不全(P <； 0.001)、多胎妊娠(P <； 0.01)、初产妇(P <； 0.001)。此外，我们确定了4个独立的VP出生危险因素：妊娠期糖尿病(P <； )、早产儿胎膜早破(P <； )、胎儿宫内窘迫(P <； 0.001)和妊娠期高血压疾病(P <； 0.001)。两两比较，孕6周28~28 + 组与孕6周29~29 + 组新生儿肺炎、支气管肺发育不良(BPD)和败血症的发生率差异有统计学意义(P <； 0.05)。与孕6周28~28 + 相比，孕26周 新生儿并发症发生率显著增加(P <； 0.05)。26~26 + 6周和27~27 + 6周新生儿颅内出血、动脉导管未闭、卵圆孔未闭、肺炎、BPD和败血症的发生率明显高于28~28 + 6周(P <； 0.05)。PPROM是EP和VP最常见的危险因素，宫颈功能不全、多胎妊娠和初产是EP出生的独立危险因素。因此，孕期应重视胎膜早破的危险因素，积极预防生殖道感染，减少胎膜早破的发生。找出宫颈功能不全的危险因素，孕前积极干预，宫颈结扎可减少EP产程的发生。对于医源性早产，应慎重权衡利弊，将孕期延长至28周以上，以提高母婴安全，改善早产结局。网上版载有补充材料，可在10.1186/s12884-022-05119-7查阅。
Preterm birth is one of the main causes of perinatal morbidity and mortality and imposes a heavy burden on families and society. The aim of this study was to identify risk factors and analyze birth conditions and complications of newborns born at < 32 gestational weeks for extremely preterm (EP) and very preterm (VP) birth in the clinic to further extend the gestational period. We performed a retrospective cohort study and collected data from 1598 pregnant women and 1660 premature newborns (excluding 229 premature babies who died due to severe illness and abandonment) admitted to the Obstetrics and Gynecology Hospital Affiliated with Nanjing Medical University in China from 2016 to 2020. We compared women’s and newborns’ characteristics by t-tests and Chi-square tests for continuous and categorical variables, respectively. Multivariable logistic regression was performed to estimate the effects of risk factors on EP and VP birth. We identified 3 independent risk factors for EP birth: cervical incompetency (P < 0.001); multiple pregnancy (P < 0.01), primipara (P < 0.001). Additionally, we identified 4 independent risk factors for VP birth: gestational diabetes mellitus (GDM) (P < 0.05), preterm premature rupture of membrane (PPROM) (P < 0.01), fetal intrauterine distress (P < 0.001), and hypertensive disorder complicating pregnancy (HDCP) (P < 0.001). In addition, pairwise comparisons revealed statistically significant differences in the incidence rates of neonatal pneumonia, bronchopulmonary dysplasia (BPD) and sepsis between the 28–28 + 6 and 29–29 + 6 weeks of gestation groups (P < 0.05). Compared with 28–28 + 6 weeks of gestation, neonatal complications were significantly more common at < 26 weeks of gestation (P < 0.05). The incidence rates of neonatal intracranial hemorrhage(NICH), patent ductus arteriosus(PDA), patent foramen ovale(PFO), pneumonia, BPD and sepsis were significantly higher in the 26–26 + 6 and 27–27 + 6 gestational weeks than in the 28–28 + 6 gestational weeks (P < 0.05). PPROM, is the most common risk factor for EP and VP birth, and cervical insufficiency, multiple pregnancy, and primipara are independent risk factors for EP birth. Therefore, during pregnancy, attention should be devoted to the risk factors for PPROM, and reproductive tract infection should be actively prevented to reduce the occurrence of PPROM. Identifying the risk factors for cervical insufficiency, actively intervening before pregnancy, and cervical cervix ligation may be considered to reduce the occurrence of EP labor. For iatrogenic preterm birth, the advantages and disadvantages should be carefully weighed, and the gestational period should be extended beyond 28 weeks to enhance the safety of the mother and child and to improve the outcomes of preterm birth. The online version contains supplementary material available at 10.1186/s12884-022-05119-7.
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DOI：
10.2147/ijwh.s364554
发表时间：
2022
期刊：
International journal of women's health
影响因子：
--
作者：
通讯作者：
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影响因子：
168.9
作者：
Morris, Jonathan M.;Roberts, Christine L.;Crowther, Caroline A.
通讯作者：
Crowther, Caroline A.
DOI：
10.1111/j.0001-6349.2005.00848.x
发表时间：
2005-06-01
影响因子：
4.3
作者：
Kyrklund-Blomberg, NB;Granath, F;Cnattingius, S
通讯作者：
Cnattingius, S
影响因子：
4.7
作者：
Mou, Jin;Fellmeth, Gracia;Cheng, Jinquan
通讯作者：
Cheng, Jinquan
非常早产的公共卫生影响。
影响因子：
2.1
作者：
Barfield WD
通讯作者：
Barfield WD