Hydramnios and small for gestational age are independent risk factors for neonatal mortality and maternal morbidity
Hydramnios and small for gestational age are independent risk factors for neonatal mortality and maternal morbidity
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DOI：
10.1007/s00404-004-0656-4
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发表时间：
2005-04-05
影响因子：
2.6
通讯作者：
Mazor, Moshe
中科院分区：
文献类型：
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作者：
Erez, Offer;Shoham-Vardi, Ilana;Mazor, Moshe
目的：目的是评估羊水过多和小于胎龄儿（SGA）作为一种综合病理对孕产妇和新生儿发病率和死亡率的贡献。研究方法：研究人群包括192例羊水过多的SGA新生儿、5,515例羊水量正常的SGA新生儿、3,714例羊水过多的适合胎龄（阿加）新生儿和83,763例羊水量正常的阿加新生儿。在四个研究组之间设计了一项基于人群的横断面研究。多元逻辑回归分析用于评估这些异常和不同的危险因素对孕产妇和围产期并发症的贡献。结果：羊水过多/SGA是围产儿死亡的独立危险因素（OR 20.55; CI 12.6-33.4）。先天性畸形、脐带脱垂、羊水过多、SGA和多胎妊娠也是围产儿死亡的独立危险因素。新生儿并发症的独立危险因素是脐带脱垂（OR 4.13; 95% CI 1.48-11.5），羊水过多/SGA（OR 2.72; 95% CI 1.81-4.07），慢性高血压（OR 2.45; 95% CI 1.02-5.9）、先天性畸形（OR 1.93; 95% CI 1.14-3.24）和SGA（OR 1.47; 95% CI 1.07-2）。分娩期医疗干预的重要独立危险因素是胎儿窘迫（OR 198.46; 95% CI 47.27-825.27），GDM B-R级（OR 21.22; 95% CI 2.34-192.25），GDM A级（OR 4.64; 95%CI 2.62-8.21），重度妊娠高血压综合征（PIH; OR 7.74; 95% CI 2.35-25.42）、羊水过多（OR 1.95; 95% CI 1.3-2.91）、羊水过多/SGA（OR 1.84; 95% CI 1.12-3.02）和胎位不正（OR 1.56; 95% CI 1.32-1.84）。结论：羊水过多合并SGA是围产儿死亡和母体并发症的独立危险因素。我们认为，这些胎儿的生长受限是负责新生儿并发症，而羊水过多主要是有助于母亲的并发症。
Objective: The objective was to evaluate the contribution of hydramnios and small for gestational age (SGA) as a combined pathology to maternal and neonatal morbidity and mortality. Methods: The study population consisted of 192 SGA neonates with hydramnios, 5,515 SGA neonates with a normal amount of amniotic fluids, 3,714 appropriate for gestational age (AGA) neonates with polyhydramnios and 83,763 AGA neonates with a normal amount of amniotic fluid. A cross-sectional population based study was designed between the four study groups. Multiple logistic regression analysis was used to assess the contribution of these abnormalities and different risk factors to maternal and perinatal complications. Results: The combination of hydramnios/SGA was found to be an independent risk factor for perinatal mortality (OR 20.55; Cl 12.6-33.4). Congenital anomalies, prolapse of cord, hydramnios, SGA and grand multiparity were also independent risk factors for perinatal mortality. Independent risk factors for neonatal complications were prolapse of umbilical cord (OR 4.13; 95% CI 1.48-11.5), hydramnios/SGA (OR 2.72; 95% CI 1.81-4.07), chronic hypertension (OR 2.45; 95% Cl 1.02-5.9), congenital malformations (OR 1.93; 95% CI 1.14-3.24) and SGA (OR 1.47; 95% CI 1.07-2). Significant independent risk factors for medical interventions during labor were fetal distress (OR 198.46; 95% Cl 47.27-825.27), GDM Class B-R (OR 21.22; 95% Cl 2.34-192.25), GDM class A (OR 4.64; 95% CI 2.62-8.21), severe pregnancy-induced hypertension (PIH; OR 7.74; 95% CI 2.35-25.42), hydramnios (OR 1.95; 95% CI 1.3-2.91), hydramnios/SGA (OR 1.84; 95% CI 1.12-3.02) and malpresentation (OR 1.56; 95% CI 1.32-1.84). Conclusion: The combination of hydramnios and SGA is an independent risk factor for perinatal mortality and maternal complications. We suggest that the growth restriction of these fetuses is responsible for the neonatal complications, while the hydramnios contributes mainly to maternal complications.