[卢本巴希初产妇的分娩：孕产妇和围产期预后]

[Childbirth among primiparous women in Lubumbashi: maternal and perinatal prognosis].

作者信息

Munan Roger, Kakudji Yves, Nsambi Joseph, Mukuku Olivier, Maleya Amani, Kinenkinda Xavier, Kakudji Prosper

机构信息

Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo.

Institut Supérieur des Techniques Médicales de Lubumbashi, République Démocratique du Congo.

出版信息

Pan Afr Med J. 2017 Sep 27;28:77. doi: 10.11604/pamj.2017.28.77.13712. eCollection 2017.

DOI:10.11604/pamj.2017.28.77.13712

PMID:29255547

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5724725/

Abstract

INTRODUCTION

Childbirth in primiparous women is associated with many complications and, therefore, primiparous women are considered high risk due to maternal and fetal concerns. This study aims to determine birth rate in primiparous women in our environment, to identify factors associated with delivery by cesarean section and to assess maternal and perinatal morbi-mortality from childbirth in primiparous women living in Lubumbashi.

METHODS

We conducted a cross-sectional, analytical study of singleton births in 10 referral maternity hospitals in Lubumbashi over the period December 2013-May 2014. Primiparous births were compared to multiparous births. Maternal sociodemographic parameters as well as maternal and perinatal morbi-mortality were analyzed. The odds ratio and its confidence interval were calculated. Threshold significance level was set at p < 0.05.

RESULTS

Primiparity rate was 19.9%. Compared to multiparous births, primiparous births were mainly observed in adolescents (OR=11. 27, (7.98-15.91)), in students (OR = 5.61 (3.33-9.45)) and in women living alone (OR=7.62 (4.36-13.30)). Risk factors associated with delivery by cesarean section in primiparous women included obstetric evacuation (OR = 9.69 (4.75-19.74)), the lack of prenatal monitoring (OR=2.57, (1.32-5.01)), size ≤ 150 cm (OR = 2.42 (1.04-5.65)), uterine height > 34 cm (OR = 2.33 (1.32-4.10)) and malpresentation (OR = 6.37 (2.92-13.87)). With regard to maternal prognosis, we observed that high blood pressure (OR = 1.91 (1.32-2.74)), malpresentation (OR = 1.95 (1.16-3.17)), oxytocin use (OR = 2.03 (1.64-2.52)), cesarean section (OR = 2.04 (1.47-2.83)), episiotomy (OR=11.89 (8.61-16.43)) and eclampsia (OR = 4.21 (1.55-11.44)) were significantly associated with primiparity. The rates of low 5th minute Apgar score (OR = 1.55 (1.03-2.32)) and of deaths occurred during early neonatal period (OR=1.80 (1.08-2.98)) were significantly higher in primiparous women than in multiparous women.

CONCLUSION

This study shows that primiparous birth is a problem in Lubumbashi. Hence improvement in mother-child care during primiparous childbirth includes the development of protocols for adequate management of childbirths.

摘要

引言

初产妇分娩会引发诸多并发症，因此，鉴于母婴健康问题，初产妇被视为高危人群。本研究旨在确定我们地区初产妇的出生率，找出与剖宫产相关的因素，并评估居住在卢本巴希的初产妇分娩时的孕产妇及围产期病率和死亡率。

方法

2013年12月至2014年5月期间，我们在卢本巴希的10家转诊妇产医院对单胎分娩进行了一项横断面分析研究。将初产妇分娩与经产妇分娩进行比较。分析产妇的社会人口统计学参数以及孕产妇和围产期的病率和死亡率。计算优势比及其置信区间。设定的显著性阈值为p < 0.05。

结果

初产率为19.9%。与经产妇分娩相比，初产妇分娩主要见于青少年（优势比=11.27，(7.98 - 15.91)）、学生（优势比 = 5.61 (3.33 - 9.45)）和独居女性（优势比=7.62 (4.36 - 13.30)）。初产妇剖宫产的相关危险因素包括产科急诊（优势比 = 9.69 (4.75 - 19.74)）、缺乏产前检查（优势比=2.57，(1.32 - 5.01)）、身高≤150厘米（优势比 = 2.42 (1.04 - 5.65)）、子宫高度>34厘米（优势比 = 2.33 (1.32 - 4.10)）和胎位异常（优势比 = 6.37 (2.92 - 13.87)）。关于孕产妇预后，我们观察到高血压（优势比 = 1.91 (1.32 - 2.74)）、胎位异常（优势比 = 1.95 (1.16 - 3.17)）、使用催产素（优势比 = 2.03 (1.64 - 2.52)）、剖宫产（优势比 = 2.04 (1.47 - 2.83)）、会阴切开术（优势比=11.89 (8.61 - 16.43)）和子痫（优势比 = 4.21 (1.55 - 11.44)）与初产显著相关。初产妇出生后第5分钟阿氏评分低（优势比 = 1.55 (1.03 - 2.32)）和新生儿早期死亡（优势比=1.80 (1.08 - 2.98)）的发生率显著高于经产妇。