| Objective:To explore the relationship between the birth weight of low-risk term infants and the perinatal outcomes of maternal and infant,and to analyze the factors affecting the birth weight of newborns,so as to provide a basis for clinical work..Methods:The thesis retrospectively collected 45984 first-time delivery women with complete case data in the Department of Obstetrics and Gynecology,The Third Affiliated Hospital of Guangzhou Medical University from January 1,2009 to December 30,2018.The women delivered full-term single infant with right position of fetal head,and the infants have no birth defects.1.The first part: According to the full term infants birth weight groups differ 100 g group,ratio of less than 1% of the group and the adjacent group merged,divided into 18 groups,analyzing each group cesarean delivery rate,cesarean section rate,incidence of labor abnormalities,postpartum hemorrhage rate,the rate of severe postpartum hemorrhage and maternal complications,severe neonatal asphyxia rate,mild neonatal asphyxia rate,neonatal complications of nine aspects statistics have differences between groups;Then,the birth weight of newborns was divided into five groups: < 2500 g,≥2500g and < 3000 g,≥3000 and < 3500 g,≥3500 and < 4000 g and ≥4000g.Thirteen different rates of cesarean section rate,cesarean section rate,abnormal rate of labor,postpartum bleeding rate,severe postpartum hemorrhage rate,maternal complications,admission to ICU,maternal outcome,severe neonatal asphyxia rate,mild neonatal asphyxia rate,neonatal complications,admission to NICU rate,and neonatal outcome were compared between the groups.To investigate the relationship between birth weight and perinatal outcomes of maternal and infants.2.The second part: When studying the factors that affect newborn weight,multiple linear regression models are used as analysis tools.Maternal situation: age,education level,previous pregnancy,conception method,pre-pregnancy BMI,weight gain during pregnancy,pregnancy checkup,delivery and gestational weeks,smoking history,alcoholism history;Situation: Gender;both included multiple linear regression models to analyze independent influencing factors.Result:1.PartⅠ:(1)The relationship between neonatal birth weight and perinatal outcomes in 18groups:(1)The cesarean section rate was the lowest in term infants with birth weight ≥2500g and < 3300 g,and the difference was statistically significant(P < 0.05).(2)The cesarean section rate was the lowest in term infants whose birth weight <3200g,and the difference was statistically significant(P < 0.05).(3)The incidence of birth weight ≥3700g was the highest in term of abnormal labor,and the difference was statistically significant(P < 0.05).(4)Full-term infants with birth weight <3000g had the lowest postpartum hemorrhage rate,≥ 4000 g and <4100g postpartum hemorrhage rate had the highest difference(P<0.05).(5)Full-term infants with a birth weight of <3400g and severe postpartum hemorrhage rate were higher than ≥3400g,the difference was statistically significant(P<0.05).(6)With the increase of body weight,the transfer rate of cesarean section,the incidence of abnormal labor,and the rate of postpartum hemorrhage are increasing.(7)Full-term infants with birth weight ≥2600g and <2700g had the lowest incidence of complications in mothers,and full-term infants with birth weight ≥3600g had the highest incidence of complications.The difference was statistically significant(P<0.05).(8)There was no significant difference in the rates of severe neonatal asphyxia and mild neonatal asphyxia among the groups(P>0.05).(9)Full-term infants with birth weight ≥ 3100 g and <3900g had the highest incidence of neonatal complications,the difference was statistically significant(P<0.05).(2)The relationship between birth weight and perinatal outcome of five groups of newborns:(1)Group 1(newborn birth weight <2500g)adverse perinatal outcomes(transfer cesarean section rate 2.3%,abnormal birth rate 0.5%,postpartum hemorrhage incidence2.9%,severe postpartum hemorrhage incidence 0.3%,newborn the incidence of complications was 19.6%),the incidence was significantly lower than other groups,with statistical differences(P <0.05).Its cesarean section rate was 35.2% in third place..(2)Group 2(newborn birth weight ≥2500g and <3000g)had a cesarean section rate of 27.1% which was significantly lower than the other four groups,with statistically significant differences(P <0.01).The remaining mothers had a bad perinatal outcome(transfer cesarean section rate 2.9 %,the incidence of postpartum hemorrhage is 3.8%,and the incidence of severe postpartum hemorrhage is 0.7%).The incidence is lower than that of other groups(P <0.05),and there is no statistical difference with the group(P>0.05).The incidence of puerperal infection was 1.2% and that of postoperative intestinal obstruction was 0.2%,which was statistically different(P <0.05).Abnormal labor rate was 2.2%,and neonatal complication rate was 28.6%..(3)Group 3(newborn birth weight ≥3000 and <3500g)maternal perinatal adverse outcomes(severe postpartum hemorrhage incidence rate 0.8%,puerperal infection rate1.5%,postoperative intestinal obstruction rate 0.1%)incidence rate is lower than other There was statistical difference between the groups(P<0.05),and no statistical difference between the two groups(P> 0.05).The cesarean section rate was 29.2% and the transfer rate was 4.5%.Abnormal birth rate was 4.4%,and the incidence of neonatal complications was 36.3%..(4)Group 4(newborn birth weight ≥3500 and <4000g)the incidence of postoperative intestinal obstruction was 0.1%,which was not statistically different from group 2 and group 3(P> 0.05).The transfer rate of cesarean section was 7.3%,the rate of postpartum hemorrhage was 7.6%,and the rate of neonatal complications was 36.7%.The rate of cesarean section was 41.0%,and the incidence of abnormal labor was 8.1%..(5)Group 5(newborn birth weight ≥4000g)64.1% cesarean section rate was significantly higher than other groups,there was a statistical difference(P <0.01),the remaining perinatal adverse outcomes(transition cesarean section rate 9.1%,labor The incidence of abnormalities was 8.9%,the incidence of postpartum hemorrhage was 8.4%,and the incidence of severe postpartum hemorrhage was 1.3%).The incidence was higher than that of other groups,with a statistical difference(P <0.05),and no statistical difference with group four.The incidence of neonatal complications was 26.8%,which was the second place,no statistical difference with group two(P> 0.05).(6)The occurrence of maternal complications: 3 cases(0.01%)of incomplete uterine rupture or complete uterine rupture,5 cases(0.02%)of perineal third or fourth degree lacerations,16 cases(0.06%)of cervical or vaginal lacerations,36 cases(1.40%)of pelvic obstetric hematoma(transvaginal delivery),717 cases(2.80%)of postpartum urinary retention,4 cases(0.02%)of urinary incontinence,392 cases(1.53%)of puerperal infection,12 cases(0.05%)of postoperative lung infection,3 cases(0.01%)of pelvic obstetric hematoma(delivery by cesarean section),42 cases(0.16%)of postoperative intestinal obstruction,and 4 cases(0.02%)of vaginal uterine prolapse.(7)The incidences of mothers entering the ICU in the five groups were 0.6%,0.2%,0.1%,0.04%,and 0%.As the birth weight of the newborn increases,the incidence of mothers entering the ICU tends to decrease.(8)There were no statistical differences between the five groups in terms of maternal outcome,incidence of severe neonatal asphyxia,incidence of neonatal mild asphyxia,incidence of neonatal entry into NICU,and neonatal outcome(P> 0.05).2.Part Ⅱ:(1)The average newborn birth weight was 3189.79 ± 390.61 g.To further determine the independent influencing factors of neonatal birth weight,the neonatal birth weight was determined as the dependent variable.Based on the univariate analysis,the statistically significant factors were independent variables.The multiple linear regression model was fitted.The results showed that: age,Education level,previous pregnancy times,conception method,pre-pregnancy BMI,weight gain during pregnancy,obstetric examination,gestational weeks of delivery,and gender of the newborn are all independent influencing factors.(2)Newborn birth weight increases with the gestational age of delivery(B =132.866),previous pregnancy times(B = 34.425),BMI before pregnancy(B = 125.527),weight gain during pregnancy(B = 57.851),and mother ’s age(B = 24.881)The weight gain was positively correlated,and the difference was statistically significant(P <0.01).(3)Newborns delivered by regular maternal examination(B = 150.383)have a significantly higher birth weight than newborns delivered by non-scheduled or non-delivery pregnant women..(4)Different methods of conception also affect the birth weight of the newborn(B =72.277).The birth weight of the newborn born by the mother of assisted reproductive technology is higher than that of the newborn born by the naturally pregnant mother..(5)Among newborns(B =-113.344),the average birth weight of male infants and female infants is about 101 g,the difference is statistically significant(P <0.01).(6)Whether pregnant women have a history of smoking or alcohol drinking is a non independent factor affecting the birth weight of newborns.Conclusion:1.The rate of cesarean section,transfer section,abnormal labor process,postpartum hemorrhage,severe postpartum hemorrhage,maternal complications(puerperal infection,postoperative intestinal obstruction),and neonatal complications of newborns whose birth weight is ≥2500g and < 3000 g are relatively low.2.In addition to gestational week of delivery,previous gestational age,pre-pregnancy BMI and neonatal gender,regular antenatal examination and weight gain during pregnancy are also important factors affecting neonatal birth weight.Standardized management of pregnancy weight gain and fetal weight should be strengthened to provide a basis for achieving good maternal and infant outcomes. |
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