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目的探讨妊娠期糖尿病(GDM)阴式分娩的安全性。方法2005年1月至2007年6月在辽阳市第三医院对92例单胎头位自愿选择阴式分娩的GDM产妇资料进行分析,并与同期单胎头位选择阴式分娩的非GDM产妇3273例进行对照比较。观察两组的分娩方式、孕产妇及胎婴儿分娩结局及对新生儿病率的影响。结果GDM组剖宫产率为19.57%,稍高于非GDM组(16.62%),但差异无统计学意义(P>0.05)。两组产后出血、胎儿窘迫、死产发生率比较无统计学意义(P>0.05)。巨大儿发生率GDM组为15.22%,非GDM组为7.52%,两组比较有统计学意义(P<0.05)。新生儿窒息GDM组为2.17%,非GDM组为0.67%,两组比较差异有统计学意义(P<0.05)。两组新生儿吸入综合征、缺氧缺血性脑病、低血钙、高胆红素血症及新生儿硬肿症的发生率比较无统计学意义(P>0.05)。新生儿低血糖发生率GDM组为5.41%,非GDM组为0,有统计学意义(P<0.05)。结论GDM组剖宫产率并未明显增加,说明GDM有阴式分娩指征者阴式分娩是较为安全的。但一旦出现延期妊娠或并发症,不宜过度等待,应适时终止妊娠。
Objective To investigate the safety of vaginal delivery in gestational diabetes mellitus (GDM). Methods From January 2005 to June 2007, 92 pregnant women with non-GDM mothers who had vaginal delivery of 92 singleton pregnancies were selected at the Third Hospital of Liaoyang City. 3273 cases for comparison. The mode of delivery, maternal and fetal infant delivery outcomes and the impact on neonatal morbidity were observed. Results The rate of cesarean section in GDM group was 19.57%, slightly higher than that in non-GDM group (16.62%), but the difference was not statistically significant (P> 0.05). Postpartum hemorrhage, fetal distress, stillbirth rate was no significant difference (P> 0.05). The incidence of macrosomia in GDM group was 15.22%, non-GDM group was 7.52%, the two groups were statistically significant (P <0.05). Neonatal asphyxia in GDM group was 2.17%, non-GDM group was 0.67%, the difference between the two groups was statistically significant (P <0.05). The incidence of neonatal respiratory syndrome, hypoxic-ischemic encephalopathy, hypocalcemia, hyperbilirubinemia and neonatal sclera in the two groups were not statistically significant (P> 0.05). The incidence of neonatal hypoglycemia was 5.41% in GDM group and 0 in non-GDM group (P <0.05). Conclusion The rate of cesarean section in GDM group did not increase significantly, indicating that vaginal delivery of GDM indications vaginal delivery is more safe. However, in the event of delayed pregnancy or complications, should not be unduly waiting, pregnancy should be terminated in due course.