Clinical Analysis Of Pregnancy Situation And Outcomes Of Multiparas Of Different Ages

BackgroundWith the gradual adjustment of the family planning policy of China in recent years,especially a shift from the Selective Two-child Policy to the Universal Two-child Policy,multiparas will account for an increasingly large proportion in the childbearing group.The social circumstance factors have resulted in the marital instability,making divorce rate and remarriage rate rise year by year.Many children die accidentally for various reasons,so some of their mothers will try every means to give birth to another child.As a result,elderly multiparas will constitute an increasingly greater proportion;on the other hand,the proportion of underage lying-in women will be on the rise because of the increased opening-up of society,the increased population mobility due to the rapid development of society,and the changes in sexual attitudes and sexual precocity.But either being too old(≥35)or being too young(≤20)is not beneficial to pregnancy and delivery.The boom of second procreation will present a new challenge to obstetrics,so it is very important to make a further research on the effects of the re-pregnancy of women of different ages on mothers and infants,to analyze the complications and perinatal outcomes in different pregnant groups and to standardize prenatal examination so as to improve the perinatal health care and thus to avoid the complications of mothers and infants and the adverse pregnancy outcomes.ObjectiveTo carry out a retrospective analysis of the general conditions multiparous women of different ages,delivery modes and pregnancy complications and differences in neonatal outcomes,so as to pay further recognition of the current multipara maternity and to propose pertinent opinions on the management of pregnancy and delivery of multiparas in different age groups to guide their gestational health care management,thus reducing maternal and fetal complications.MethodsMultiparous parturient who had stayed and labored in the obstetrics and gynecology department in our hospital during the time from January 1,2013 to December 31,2016 were chosen as the study subjects,who were divided into Underage Multiparas Group(UMG),Multiparas of Prime Childbearing Age Group(MPG)and Elderly Multiparas Group(EMG).Retrospective analysis was made concerning their general conditions,the delivery modes and pregnancy complications and differences in neonatal outcomes.Differences were compared in terms of pregnancy complications of multiparas of different age groups,delivery modes and neonatal outcomes.Results1.Pregnancy complications(1)Postpartum hemorrhage: Its incidence was higher in EMG than in MPG(P<0.01),with no statistically significant difference between EMG and UMG or between UMG and MPG(P>0.05)(2)Pregnancy-induced hypertension syndrome: Its incidence was higher in EMG than in MPG(P<0.05)and there was no statistically significant difference between EMG and MPG(P>0.05).(3)Premature rupture of fetal membranes: Its incidence was higher in EMG than in UMG(P<0.05)and higher in MPG than in UMG.There was no statistically significant difference between EMG and MPG(P>0.05).(4)Placenta implantation: Its incidence was higher in EMG than in MPG(P<0.05),with no statistically significant difference between EMG and UMG(P>0.05).There was no statistically significant difference between UMG and MPG(P>0.05).(5)Pregnancy anemia: Its incidence was lower in EMG than in MPG(P<0.01),with no statistically significant difference between EMG and UMG(P>0.05).There was no statistically significant difference between UMG and MPG(P>0.05).(6)Pregnancy with SYD(sexually transmitted disease): Its incidence was higher in EMG than in MPG(P<0.05),with no statistically significant difference between EMG and UMG(P>0.05).There was no statistically significant difference between UMG and MPG(P>0.05).(7)Uterine myoma: Its incidence was higher in EMG than in MPG(P<0.05),with no statistically significant difference between EMG and UMG(P>0.05).There was no statistically significant difference between UMG and MPG(P>0.05).2.Incidence of premature delivery and prolonged pregnancy(1)Premature delivery: Its incidence was higher in EMG than in MPG(P<0.05),with no statistically significant difference between EMG and UMG(P>0.05).There was no significant statistical difference between UMG and MPG(P>0.05).(2)Prolonged pregnancy: Its incidence was higher in UMG than in MPG(P<0.05),with no statistical significance compared with EMG(P>0.05).There was no significant statistical difference between EMG and MPG(P>0.05).3.Experiences of previous perinatal death and situation of setting files for current pregnancy:(1)The incidence of experiencing previous perinatal death was higher in UMG than in MPG(P<0.05),with no statistical significance compared with EMG(P>0.05).There was no significant statistical difference between UMG and MPG(P>0.05).There was no statistically significant difference between MPG and EMG(P>0.05).(2)Rate of setting files for current pregnancy: It was higher in MPG than in EMG(P<0.01)and than in UMG(P<0.01).There was no statistically significant difference between UMG and EMG(P>0.05)4.Perinatal outcomes(1)Macrosomia: Its incidence was higher in EMG than in MPG(P<0.05)and UMG(P<0.05).There was no statistically significant difference between UMG and MPG(P>0.05).(2)IUGR: Its incidence was higher in EMG than in MPG(P<0.05),with no statistical difference between EMG and UMG(P>0.05).Its incidence was higher in UMG than in MPG(P<0.05).5.Mode of delivery:(1)The rate of caesarean section: It was higher in EMG than in MPG(P<0.05)and than in UMG((P<0.01).It is higher in MPG than in UMG(P<0.01).Rate of failing in eutocia was higher in EMG than in MPG(P<0.01).6.Indications of caesarean section:(1)In EMG the first three indications were: cicatricial uterus,abnormal fetal position and hypamnion.(2)In MPG,the first three indications were arranged in the following sequence: cicatricial uterus,hypamnion and abnormal fetal position.(3)In UMG the first three indications were in the following sequence: cicatricial uterus,abnormal fetal position and cephalopelvic disproportionConclusions:1.By comparing elderly multiparas with multiparas of prime childbearing age,it was found that the incidences of postpartum hemorrhage,pregnancy-induced hypertension syndrome,premature rupture of fetal membranes,placenta implantation,pregnancy with SYD(sexually transmitted disease)and uterine myoma were on the rise.But the rate of setting files for standard obstetric examinations is lower than in MPG.It is necessary to attach importance to publicity and education of antenatal health care and screening,so as to detect and treat pregnancy complications as early as possible,thus improving pregnancy outcomes.The incidence of postpartum hemorrhage was arranged from high to low as follows,EMG,UMG and MPG.The incidence of GDM in EMG was higher than both EMG and UMG,with no significant statistical difference between them,which needs to be further studied with more samples.2.The incidence of macrosomia was higher in EMG than in MPG and UMG;The incidence of IUGR was higher in EMG and UMG than in MPG.The incidence of experiencing previous perinatal death was higher in UMG than in MPG.It is necessary to enhance antenatal care for those special childbearing groups and to detect fetal abnormality timely.3.The rate of caesarean section increased with age advancing,with cicatricial uterus being the primary indication.For those multiparas with cicatricial uterus who are pregnant again,it is necessary to attach importance to the assessment and research on the related indication of vaginal delivery in an effort to encourage vaginal delivery,thus reducing the rate of caesarean section.