| Part 1: The Analysis of Macrosomia's Maternal and Perinatal OutcomesObjective:To compare the difference of maternal and neonatal adverse pregnancy outcomes of macrosomia and non-macrosomia.Materials and methods:The total amount of labour in Shanghai Putuo Hospital between 2010 to 2014 was recorded. Patients were divided into two groups according to their babies' birth weight,one was macrosomia group(newborn weight ? 4000g),another was non-macrosomia group(newborn weight < 4000g).Their information was recorded including pregnant women's age,gravidity,parity,duration of labour,amount of bleeding during labour,Apgar score,complications of vaginal labour and caesarean section.Then,the difference of maternal and neonatal adverse pregnancy outcomes of macrosomia and non-macrosomia was analyzed.Results:The total amount of labour is 7701 in Shanghai Putuo Hospital between 2010 to2014.The caesarean section rate is 53.77%.The amount of macrosomia is 647.The caesarean section rate of macrosomia reaches up to 67.23%.The gravidity and parity of those women who delivered macrosomia by vagina is much more than those who delivered macrosomia by caesarean section(P<0.05).The first and second stage of labour of those who delivered macrosomia is much longer than those of who delivered non-macrosomia(P<0.05).But their third stage of labour has no significant difference(P<0.05).The amount of bleeding during labour of women that delivered macrosomia is more than those of who delivered non-macrosomia(P<0.05).The rate of postpartum hemorrhage,gestational diabetic mellitus,fetal distress and cephalopelvic disproportion is much higher in those who delivered macrosomia than in those who delivered non-macrosomia(P<0.05).Puerperas who delivered macrosomia by vagina have higher risk of severe perineal laceration and forceps delivery(P<0.05).The rate of asphyxia,clavicle fracture and hypoglycemia of macrosomia is much higher than non-macrosomia(P<0.05).Conclusion:Fetal macrosomia is associated with maternal complications such as prolonged labour,caesarean and instrumental delivery,postpartum hemorrhage,cephalopelvic disproportion fetal distress.Fetal macrosomia is also associated with neonatal complications such as traumatic birth injury,birth asphyxia,hypoglycemia.Those complications affects maternal and neonatal outcomes to large extent.Part 2:The Study of Risk Factors of Macrosomia in Non-diabetic Pregnant WomenObjective:To explore high risk factors of macrosomia in non-diabetic pregnant women.Materials and methods:800 non-diabetic pregnant women who met the research standards were selected.They were divided into two groups according to their babies' birth weight,one was macrosomia group(newborn weight ? 4000g),another was non-macrosomia group(newborn weight < 4000g).Their serum level of fasting blood glucose(FBG),C-reactive protein(CRP),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol( HDL-C) and low density lipoprotein cholesterol(LDL-C) in late trimester of pregnancy were measured.Their basic information was recorded including age,gravidity,parity,height,weight( before and after pregnancy),gestational age of delivery,delivery mode,laboratory data,newborn birth weight and gender.Results:(1)The serum level of TG and TC of the macrosomia group is much higher than that of the non-macrosomia group(P<0.05),but the level of HDL-C of the macrosomia group is lower than that of the non-macrosomia group(P<0.05);(2)The serum level of CRP of the macrosomia group is much higher than that of the non-macrosomia group(P< 0.05).The level of FBG of the two groups has no significance difference(P >0.05);(3)The gestational age of the macrosomia group is much longer than that of the non-macrosomia group(P<0.05),and the weight before pregnancy and the weight gain during pregnancy of the two groups has significant difference(P < 0.05);(4)The age,gravity and parity of the two groups has no significance difference(P >0.05);(5)Birth weight and the level of TG has positive correlation(P < 0.05).Birth weight and the level of HDL-C has negative correlation(P<0.05).But birth weight and the level of FBG and TC has no correlation(P>0.05).Conclusion:The abnormal lipid profile,high level of CRP,high weight before pregnancy and excessive weight gain during pregnancy are important risk factors of macrosomia.Lipid profile should be examined at regular periods.Proper physical activities and a balanced diet can control the lipid profile and reduce the risk of macrosomia,therefore,the maternal and neonatal outcomes of macrosomia can be improved. |
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