Usha Kiran T S, Hemmadi S, Bethel J, Evans J
Department of Obstetrics and Gynaecology, University Hospital of Wales and Llandough Hospital Trust, Cardiff, UK.
BJOG. 2005 Jun;112(6):768-72. doi: 10.1111/j.1471-0528.2004.00546.x.
To show the increased risk of adverse outcomes in labour and fetomaternal morbidity in obese women (BMI > 30).
A population-based observational study.
University Hospital of Wales. The study sample was drawn from the Cardiff Births Survey, a population-based database comprising of a total of 60,167 deliveries in the South Glamorgan area between 1990 and 1999. Population Primigravid women with a singleton uncomplicated pregnancy with cephalic presentation of 37 or more weeks of gestation with accurate information regarding height and weight recorded at the booking visit (measured by the midwives) were included in the study.
Comparisons were made between women with a body mass index of 20-30 and those with more than 30. SPSS version 10 was used for statistical analysis. Student's t test, chi(2) and Fisher's exact tests were used wherever appropriate.
Labour outcomes assessed were risk of postdates, induction of labour, mode of delivery, failed instrumental delivery, macrosomia and shoulder dystocia. Maternal adverse outcomes assessed were postpartum haemorrhage, blood transfusion, uterine and wound infection, urinary tract infection, evacuation of uterus, thromboembolism and third- or fourth-degree perineal tears. Fetal wellbeing was assessed using Apgar <7 at 5 minutes, trauma and asphyxia, cord pH < 7.2, babies requiring neonatal ward admissions, tube feeding and incubator.
We report an increased risk [quoted as odds ratio (OR) and confidence intervals CI)] of postdates, 1.4 (1.2-1.7); induction of labour, 1.6 (1.3-1.9); caesarean section, 1.6 (1.4-2); macrosomia, 2.1 (1.6-2.6); shoulder dystocia, 2.9 (1.4-5.8); failed instrumental delivery, 1.75 (1.1-2.9); increased maternal complications such as blood loss of more than 500 mL, 1.5 (1.2-1.8); urinary tract infections, 1.9 (1.1-3.4); and increased neonatal admissions with complications such as neonatal trauma, feeding difficulties and incubator requirement.
Obese women appear to be at risk of intrapartum and postpartum complications. Induction of labour appears to be the starting point in the cascade of events. They should be considered as high risk and counselled accordingly.
展示肥胖女性（BMI>30）分娩时不良结局及母胎发病风险的增加。
基于人群的观察性研究。
威尔士大学医院。研究样本取自卡迪夫出生调查，这是一个基于人群的数据库，包含1990年至1999年南格拉摩根地区总共60167例分娩。纳入研究的人群为初产妇，单胎妊娠无并发症，孕37周及以上且头先露，在预约产检时（由助产士测量）记录有准确的身高和体重信息。
对体重指数在20 - 30之间的女性与体重指数超过30的女性进行比较。使用SPSS 10版进行统计分析。在适当情况下使用学生t检验、卡方检验和费舍尔精确检验。
评估的分娩结局包括过期妊娠风险、引产、分娩方式、器械助产失败、巨大儿和肩难产。评估的母体不良结局包括产后出血、输血、子宫和伤口感染、尿路感染、清宫、血栓栓塞以及会阴三度或四度撕裂。通过5分钟时阿氏评分<7分、创伤和窒息、脐动脉血pH<7.2、需要入住新生儿病房的婴儿、管饲和使用暖箱来评估胎儿健康状况。
我们报告过期妊娠风险增加[表示为比值比（OR）和置信区间（CI）]，为1.4（1.2 - 1.7）；引产风险为1.6（1.3 - 1.9）；剖宫产风险为1.6（1.4 - 2）；巨大儿风险为2.1（1.6 - 2.6）；肩难产风险为2.9（1.4 - 5.8）；器械助产失败风险为1.75（1.1 - 2.9）；母体并发症增加，如失血超过500 mL的风险为1.5（1.2 - 1.8）；尿路感染风险为1.9（1.1 - 3.4）；以及因新生儿创伤、喂养困难和需要使用暖箱等并发症导致的新生儿入院率增加。
肥胖女性似乎存在分娩期和产后期并发症的风险。引产似乎是一系列事件的起始点。应将她们视为高危人群并给予相应的咨询。
