| Objective:The differences in pregnancy complications,delivery patterns and outcomes were compared to elderly primipara and multipara with multipara of the right age.Discuss the risk factors for the adverse outcome of pregnancy.In order to provide reference for strengthening the perinatal health care,management and improvement of pregnancy outcomes in the advanced age parturient woman after the implementation of the two child policy.Methods:1.Analysis of pregnancy outcomes: Adopt the method of retrospective analysis compared with elderly women and right age women,elderly primipara and elderly multipara,elderly multipara and multipara in pregnancy complications and complications,delivery mode,the pregnancy outcome,perinatal outcome,birth weight and gestational age.A total of 1019 elderly women(aged?35years)who were hospitalized delivery in the Northwest Women and Children Hospital from January 2015 to December 2015 were selected as the observation group.Among them,268 were elderly primipara and 751 were elderly multipara.1019 cases in accordance with the ratio of 1:1 were randomly selected age period of delivery in hospital(age<35 years)of pregnant women as the control group,of which 779 were primipara and 240 were multipara.The age,nationality,household registration,education and other general demographic information and pregnancy complications and complications,mode of delivery,cesarean section indications,pregnancy outcome,perinatal outcome,neonatal weight and gestational age and other clinical data were recorded.The differences between the three groups were compared.2.Analysis of adverse pregnancy outcomes: In accordance with the method of case-control study,283 cases of maternal which had a bad pregnancy outcome form 2038 cases of pregnant women as the study group,according to the ratio of 1:4,randomly selected 1132 cases of no adverse pregnancy outcomes of pregnant women as control group,the influencing factors were analyzed by univariate analysis and multivariate logistic regression analysis,to screen risk factors for adverse pregnancy outcomes.Results:1.Natural conceptionThe natural pregnancy rate,the advanced women group(90.5%)was significantly lower than the right age group(93.8%),P<0.05;the elderly primipara group(73.1%)was significantly lower than that in the elderly multipara group(96.7%),P<0.05;the elderly multipara group was significantly lower than that of the multipara in the right age group(99.2%),P<0.05.2.Pregnancy complications and complications(1)Pregnancy complications: The incidence of complications in the elderly group(57.1%)was significantly higher than the right age group(43.0%),P<0.05;the elderly primipara group(65.7%)higher than the elderly multipara group(54.1%),P<0.05;the elderly multipara group was higher than that of the multipara in the right age group(39.2%),P<0.05.(1)Hypertensive disorder complicating pregnancy: The incidence of hypertension,in the elderly group(16.6%)was significantly higher than the right age group(6.5%),P<0.05;the elderly primipara group had no significant difference with the elderly multipara group;the elderly multipara group(16.0%)was higher than that of the multipara in the right age group(3.8%),P<0.05.(2)Gestational diabetes mellitus: There was no significant difference in gestational diabetes mellitus between the elderly group and the right age group;the elderly primipara group(1.5%)was lower than the elderly multipara group(19.0%),P<0.05;the elderly multipara group was higher than that of multipara in the right age group,P<0.05.(3)Thyroid disease: The incidence of thyroid disease,there were no significant difference between the elderly group and the right age group,the elderly multipara group and the multipara in the right age group;the elderly primipara group(9.7%)was higher than the elderly multipara group(5.1%),P<0.05.(4)Uterine fibroids: The incidence of uterine fibroids,the elderly group(7.7%)was higher than the right age group(1.8%),P<0.05;the elderly primipara group(11.2%)was higher than the elderly multipara group(6.4%),P<0.05;the elderly multipara group was higher than that of the multipara in the right age group(1.3%),P<0.05.(2)Complications of pregnancy: The incidence of complications,the elderly group(10.9%)was higher than the right age group(7%),P<0.05;there were no significant difference between the elderly primipara group and the elderly multipara group,the elderly multipara group and the multipara in the right age group.(1)Placental adhesions: The differences of placental adhesions between the groups were not statistically significant.(2)Placental abruption: The incidence of placental abruption in the elderly group(0.2%)waslower than the right age group(3.7%),P<0.05;there were no significant difference between the elderly primipara group and the elderly multipara group,the elderly multipara group and the multipara in the right age group.3.Delivery mode(1)Natural childbirth: The rate of natural delivery in the elderly group(36.0%)was significantly lower than that of the right age group(56.9%),P<0.05;the elderly primipara group(29.5%)was lower than the elderly multipara group(38.2%),P<0.05;the elderly multipara group was lower than that of the multipara in the right age group(47.5%),P<0.05.(2)Cesarean section indications and position(1)The cesarean section indications and the proportion for the elderly group in the top four were as follows: the previous cesarean section(47.1%),P<0.05,elderly primipara(13.8%),twins(5.4%),other complications of pregnancy(4.9%).(2)The cesarean section indications and the proportion for the elderly multipara group in the top four were as follows: The previous cesarean section(65.1%),other complications of pregnancy(4.1%),breech position(3.9%)and severe preeclampsia(3.9%).(3)The cesarean section indications and the proportion for the elderly primipara group in the top four were as follows: elderly primipara(41.8%),twins(9.5%),other complications of pregnancy(6.9%),breech position(6.9%).(4)The cesarean section indications and the proportion for the right age group in the top four were as follows: other complications of pregnancy(23.5%),the previous cesarean section(22.6%),breech position(8.9%),hypamnion(7.5%)and twins(7.5%).(5)The cesarean section indications and the proportion for the multipara of the right age group in the top four were as follows: the previous cesarean section(75.4%),breech position(8.7%),other complications of pregnancy(2.4%),transverse position(2.4%).4.Perinatal outcome(1)Gestational age: The average gestational age of the elderly group(38.0±0.7weeks)was lower than that the right age group(39.0±0.2weeks),P<0.05.There were no significant difference between the elderly primipara group(38.6±2.1weeks)and the elderly multipara group(38.7±1.9weeks),the elderly multipara group and the multipara in the right age group(39.0±1.9weeks).(2)Body weight: There was no significant difference between the elderly group(3200.2±580.8g)and the right age group(3201.1±610.3g),the elderly multipara group(3255.2±586.8g)and the multipara in the right age group(3304.1±536.6g).The average body weight of the elderly primipara group(3055.1±611.6g)was lower than that of the elderly multipara group(3255.2±586.8g),P<0.05.5.Analysis of adverse pregnancy outcomes(1)Single factor Logistic regression analysis: Multiple pregnancy,pregnancy complications,postpartum hemorrhage,way of conception,ovarian disease,tubal disease,hypertensive disorder complicating pregnancy,delivery mode,early pregnancy illness,chronic disease history,placenta adhesion,complications of pregnancy,anemia,prenatal examination,the degree of education,the household registration were the risk factors for adverse pregnancy outcomes.(2)Multivariable logistic regression analysis: The risk factors and the 95% OR value for adverse pregnancy outcomes were as follows: multiple pregnancy(20.990~82.077),pregnancy complications(3.551~9.424),hypertensive disorder complicating pregnancy(1.139~4.172),irregular prenatal examination(1.136~2.664);thyroid disease in pregnancy(0.105~0.627),No glucose tolerance test(0.230~3.054),multiparous(0.308~0.943)and abnormal glucose tolerance test results(0.585~1.401).Conclusion:1.The natural pregnancy rate of elderly women was decreased,and the prevalence rate of hypertension,diabetes mellitus and uterine fibroids in pregnant women was higher.2.The rate of cesarean section was significantly higher in the elderly,and the previous cesarean section,the elderly primipara and twins were the main indications of cesarean section.Premature birth is premature in elderly primipara.3.Multiple pregnancy,complications of pregnancy,hypertensive disorder complicating pregnancy,irregular prenatal examination,thyroid disease in pregnancy,multiparous,abnormal glucose tolerance test results were the risk of adverse pregnancy outcome factors.Older pregnancies increase the risk of mother and child.It is suggested that women who have a desire for childbearing should be prepared to have a planned and prepared pregnancy for their physical,work,and economic conditions.The plan for pre-pregnancy health examination should be further advanced and do a good job of maternal health care for minimizing the risk of adverse pregnancy outcomes. |
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