Maternal and neonatal outcomes of grand multiparas over two decades in Mali
Maternal and neonatal outcomes of grand multiparas over two decades in Mali
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DOI：
10.1111/j.1600-0412.2012.01372.x
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发表时间：
2012-05-01
影响因子：
4.3
通讯作者：
Leppert, Phyllis C.
中科院分区：
文献类型：
--
作者：
Teguete, Ibrahima;Maiga, Amelia W.;Leppert, Phyllis C.
Objective.分析多次产与孕产妇和新生儿发病率和死亡率之间的关系。设计回顾性横断面研究。设置. G点国家医院，一家位于马里巴马科的三级护理医院。人口1985年至2003年的所有单胎出生。方法.对马里一家三级保健医院的13340例单胎分娩进行的横断面研究（1985 - 2003年）比较了3617例多胎妊娠（第5段）和9723例少胎妊娠（第14段）的结局。比值比（OR）调整了母亲的年龄，产前护理的利用，社会经济地位，和原产地。主要结果指标。孕产妇死亡率、围产期死亡率、胎盘异常（前置和前置）、子宫破裂、产后感染、产后出血、子痫、剖宫产、平均出生体重、低出生体重、高出生体重。结果大产妇年龄较大，较穷，不太可能获得产前护理。多胎妊娠有较低的调整后的孕产妇死亡率（校正OR，0.66; 95%CI，0.45 - 0.97），但围产儿死亡的校正比值比更高（校正OR，1.33; 95%CI，1.121.59），胎盘异常（校正OR，1.57; 95%CI，1.21 - 2.05）和高出生体重（校正OR，1.42; 95%CI，1.05 - 1.92）。结论.健康人效应可以解释产妇死亡率极低的原因。减少多胎妊娠和改善多胎妊娠获得产前护理可能会改善人口水平的围产期结局。
Objective. To analyze the association between grand multiparity and maternal and neonatal morbidity and mortality. Design. Retrospective cross-sectional study. Setting. Point G National Hospital, a tertiary care hospital in Bamako, Mali. Population. All singleton births from 1985 to 2003. Methods. Cross-sectional study of 13 340 singleton births at a tertiary care hospital in Mali (19852003) compared outcomes between 3617 grand multiparas (para =5) and 9723 pauciparas (para 14). Odds ratios (OR) were adjusted for maternal age, prenatal care utilization, socioeconomic status, and region of origin. Main outcome measures. Maternal mortality, perinatal mortality, placental abnormalities (previa and abruption), uterine rupture, postpartum infection, postpartum hemorrhage, eclampsia, cesarean delivery, mean birthweight, low birthweight, high birthweight. Results. Grand multiparas were older, poorer, and less likely to have accessed prenatal care. Grand multiparas had a lower adjusted odds of maternal death (adjusted OR, 0.66; 95%CI, 0.450.97), but higher adjusted odds of perinatal death (adjusted OR, 1.33; 95%CI, 1.121.59), placental abnormalities (adjusted OR, 1.57; 95%CI, 1.212.05), and high birthweight (adjusted OR, 1.42; 95%CI, 1.051.92). Conclusions. The healthy person effect may explain grand multiparas lower odds of maternal death. Reducing grand multiparity and improving grand multiparas access to prenatal care may improve population-level perinatal outcomes.