Obstetric and neonatal outcome of babies weighing more than 4.5 kg: an analysis by parity
Obstetric and neonatal outcome of babies weighing more than 4.5 kg: an analysis by parity
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DOI：
10.1016/s0301-2115(99)00280-8
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发表时间：
2000-10-01
期刊：
影响因子：
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通讯作者：
Turner, MJ
中科院分区：
文献类型：
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作者：
Mocanu, EV;Greene, RA;Turner, MJ
目的：通过产次分析出生体重超过4.5 kg的婴儿的产科和新生儿结局。研究方法：在1991年至1995年的五年中，所有婴儿体重超过4.5公斤的分娩都是通过计算机数据库确定的。以下变量仅限于单胎，头位妊娠记录：分娩方式，劳动力的持续时间，肩难产的发生率和新生儿中心入院。使用Epi Info软件包（WHO，版本6.0b，1997年1月）比较经产妇和经产妇的结局指标。结果：在研究期间有32，834例分娩，828例（2.5%）体重超过4.5 kg。经产妇体重超过4.5kg的发生率为3.1%（n = 630），而经产妇为1.6%（n = 198）（P < 0.05）。与经产妇相比，初产妇分娩时间延长（27.7% vs. 4.9%）、阴道手术分娩（32% vs. 9%）和紧急剖腹产（24.2% vs. 5.7%）的风险更高。当分娩巨大婴儿时，与正常体重的婴儿相比，孕妇的产程延长（27%对7.9%）、手术阴道分娩（32%对25%）和紧急剖腹产（24.2%对5.7%）的发生率更高。肩难产和选择性剖宫产的发生率在经产妇和产妇中相似。结论：与正常体重的婴儿相比，巨大儿的产程延长、阴道手术分娩和紧急剖腹产的发生率增加，这些并发症在双胎妊娠中比经胎妊娠更明显。肩难产在经产妇和经产妇中发生率相同。巨大儿的产前预测性差，阴道分娩率高，肩难产的发生率低，不支持选择性剖宫产用于分娩巨大儿，无论是在经产妇或经产妇。(C)2000爱思唯尔科学爱尔兰有限公司保留所有权利。
Objectives: To analyse by parity the obstetric and neonatal outcome of babies delivered weighing more than 4.5 kg. Methods: All deliveries resulting in a baby weighing more than 4.5 kg, in the 5 years from 1991 to 1995, were identified using a computerised database. The following variables confined to singleton, cephalic pregnancies were recorded: mode of delivery, duration of labour, incidence of shoulder dystocia and admission to the neonatal centre. Outcome measures in primigravidae and multigravidae were compared using the Epi Info package (WHO, Version 6.0b January 1997). Results: There were 32,834 deliveries over the study period and 828 (2.5%) weighed more than 4.5 kg. Birthweight more than 4.5 kg occurred in 1.6% (n = 198) of primigravidae and 3.1% (n = 630) of multigravidae (P < 0.05). Primigravidae had a higher risk of prolonged labour (27.7% vs. 4.9%), operative vaginal delivery (32% vs. 9%) and emergency caesarean section (24.2% vs. 5.7%) compared to multigravidae. When delivering a macrosomic baby, primigravidae had a higher incidence of prolonged labour (27% vs. 7.9%), operative Vaginal delivery (32% vs. 25%) and emergency caesarean section (24.2% vs. 5.7%) compared to normal weight babies. The incidence of shoulder dystocia and elective caesarean section were similar in both primigravidae and multigravidae. Conclusions: Macrosomic infants have an increased incidence of prolonged labour, operative vaginal delivery and emergency caesarean section compared with normal weight babies and these complications are more pronounced in primigravidae compared to multigravidae. Shoulder dystocia occurs with equal frequency in primigravidae and multigravidae. The poor antenatal predictability of macrosomia, the high rate of vaginal delivery and the low incidence of shoulder dystocia would not support the use of elective caesarean section for delivery of the macrosomic infant either in primigravidae or multigravidae. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.