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目的探讨不同孕周终止妊娠对新诊断标准下足月妊娠的妊娠期糖尿母婴结局的影响。方法对2012至2014年南京市妇幼保健院足月妊娠分娩的347例妊娠期糖尿病患者的临床资料进行回顾性分析,根据终止妊娠的不同孕周,分为3组:A组,妊娠37~38+6周;B组,妊娠39~40周;C组,妊娠>40周。对母婴妊娠结局进行统计分析,包括孕母并发症(如剖宫产率、产钳助娩率以及羊水过多、糖尿病酮症酸中毒、产后出血等发病率)和围产儿并发症(如巨大儿、新生儿低血糖、新生儿呼吸窘迫综合征、新生儿窒息以及新生儿死亡率)等相关临床指标。计数资料组间比较采用R×C表χ~2检验及其分割,采用分割法两两比较时检验水准校正为α’=0.017。结果 A、B组间手术产率及妊娠期并发症发生率比较无统计学差异(P均>0.017),而C组剖宫产率、羊水过多及产后出血率显著高于A、B组(P均<0.017);C组巨大儿发生率显著高于A、B组,B、C组新生儿呼吸窘迫综合征、新生儿窒息发病率显著低于A组,差异均有统计学意义(P均<0.017)。结论妊娠期糖尿病患者严格控制血糖平稳,可有效降低母婴并发症;妊娠期糖尿病患者妊娠39~40周终止妊娠可以显著降低母婴并发症,有效改善围产儿结局。
Objective To investigate the effects of gestational weeks of different gestational weeks on the outcome of gestational diabetes mellitus in full-term pregnancy under the new diagnostic criteria. Methods The clinical data of 347 cases of gestational diabetes mellitus given during full-term pregnancy in Nanjing Maternal and Child Health Hospital from 2012 to 2014 were retrospectively analyzed. According to different gestational weeks of termination of pregnancy, the patients were divided into three groups: Group A, 37-38 +6 weeks; Group B, 39-40 weeks of gestation; Group C, pregnancy> 40 weeks. Maternal and child pregnancy outcomes were analyzed statistically, including maternal complications (such as cesarean section rate, forceps delivery rate and polyhydramnios, diabetic ketoacidosis, postpartum hemorrhage incidence) and perinatal complications (such as huge Children, neonatal hypoglycemia, neonatal respiratory distress syndrome, neonatal asphyxia and neonatal mortality) and other related clinical indicators. Counting data between groups using R × C table χ ~ 2 test and its segmentation, the use of segmentation method to compare the level of each test for the calibration of α ’= 0.017. Results There was no significant difference in operative rate and incidence of complications during pregnancy in group A and group B (all P> 0.017), while the rate of cesarean section, polyhydramnios and postpartum hemorrhage in group C were significantly higher than those in groups A and B (P <0.017). The incidence of macrosomia in group C was significantly higher than that in group A, B and B and C, and the incidence of neonatal asphyxia was significantly lower than that in group A P <0.017). Conclusion Gestational diabetic patients with strict control of stable blood glucose, which can effectively reduce the maternal and infant complications; Gestational diabetes in 39 to 40 weeks of gestation termination of pregnancy can significantly reduce maternal and neonatal complications, and effectively improve the outcome of perinatal children.