| Objective:To explore the characteristics of elderly multipara in pregnancy complications,delivery mode,perinatal prognosis and other aspects,so as to provide a theoretical basis for the management of elderly multipara during pregnancy and delivery.Aims to improve the pregnancy outcome and reduce maternal and infant complications.Method:Retrospective study included 4113 cases of gestational age of 28 weeks or more singletons multipara from November 2016 to October 2018 in Tianjin Binhai New Area Tanggu Obstertrics and gynecology hospital,including pregnancy complications,delivery mode,delivery outcome,amniotic fluid and placenta,and the perinatal outcome.Stratified statistical analysis of case data was performed by age group.We analyze data by SPSS 20.0.Result:1.Pregnancy complications,the abnormity of fetus appendants:(1)Hypertensive disorder complicating pregnancy: The incidence of Hypertensive disorder complicating pregnancy in elderly multipara group is higher than that of the age-appropriate multipara group(P<0.05);The incidence of gestational hypertension increased with age,and is higher in the over 40 years old and38-40 years old(P<0.05).(2)Gestational diabetes mellitus(GDM): The incidence of GDM in elderly multiparas group is higher than that of the age-appropriate multipara group(P<0.05).The incidence of GDM in over 40 years old is higher than that of 35-37 years old(P<0.05).(3)Myoma of uterus: The incidence of myoma of uterus in elderly multiparas group is higher than that of the age-appropriate multipara group(P<0.05).The incidence of myoma of uterus in over 40 years old is higher than that of 35-37 years old(P<0.05).(4)Anemia,hypothyroidism,pregnancy with scar uterus: the incidence in elderly multiparas group is higher than that of the age-appropriate multipara group(P<0.05).There is no difference among the different age groups of the elderly multiparas(P>0.05).(5)Premature rupture of fetal membranes,polyhydramnios and adherent placenta : the incidence in elderly multiparas group is higher than that of the age-appropriate multipara group(P<0.05).There is no difference among the different age groups of the elderly multiparas(P>0.05).(6)Placenta previa,placental abruption,oligoamnios,premature delivery,post-term pregnancy,postpartum hemorrhage: there is no difference between elderly multiparas and the age-appropriate multipara group(P>0.05).And there is no difference among the different age groups of the elderly multiparas(P>0.05).(7)Ranking of the top three diseases with high incidence:The top three diseases in the age-appropriate multipara group were: 1)anemia during pregnancy 2)pregnancy with scar uterus 3)gestational diabetes;and in elderly multipara group is Pregnancy with uterine scar,anemia during pregnancy,gestational diabetes mellitus respectively.2.Prinatal outcomes(1)Fetal macrosomia: the incidence in elderly multiparas group is higher than that of the age-appropriate multipara group(P<0.05).There is no difference among the different age groups of the elderly multiparas(P>0.05).(2)Neonatal asphyxia: There is no statistic difference between the elderly multiparas and age-appropriate multipara group(P>0.05).The incidence of neonatal asphyxia in over 40 years old is higher than that of 35-37 years old(P<0.05).(3)Fetal distress: The incidence increased with age without statistical significance(P>0.05)。(4)Neonatal malformation,low birth weight,stillbirth: There is no difference among the different age groups(P>0.05).3.Delivery modes(1)Caesarean section: The incidence of Caesarean section in elderly multiparas group is higher than that of the age-appropriate multipara group(P<0.05).Theincidence of Caesarean section is more higher in the over 40 years old group(P<0.05).(2)Vaginal delivery: The incidence of vaginal delivery in elderly multiparas group is lower than that of the age-appropriate multipara group(P<0.05).The incidence of Caesarean section is more lower in the over 40 years old group(P<0.05).(3)Forceps delivery: There is no difference among the different age groups(P>0.05).4.Indications of Caesarean section in elderly multiparas:(1)Pregnancy complications: The proportion of Pregnancy complications in over 40 years old group is higher than that of 35-37 years old(P<0.05).(2)Social factor: The proportion of social factor in over 40 years old group is higher than that of 35-37 years old(P<0.05).(3)Oligoamnios: The proportion of oligoamnios in over 40 years old group is higher than that of 35-37 years old(P<0.05).(4)Pregnancy with uterine scar: The proportion of uterine scar in over 40 years old group is lower than that of 35-37 years old(P<0.05).There is no difference among the different age groups of elderly multiparas aged under 40(P>0.05).(5)Fetal distress,placental previa,placental abruption,cephalopelvic disproportion,abnormal fetal position and fetal macrosomia: There is no difference among the different age groups of the elderly multiparas(P>0.05).(6)Ranking of the top three indications of Caesarean section in elderly multiparas:The top three indications of Caesarean section in the over 40 years old group are pregnancy with uterine scar,cephalopelvic disproportion,pregnancy complications and social factors;and the 37-40 group are pregnancy with uterine scar,abnormal fetal position and cephalopelvic disproportion;the 35-37 group are pregnancy with uterine scar,cephalopelvic disproportion,and fetal macrosomia respectively.Conclusions(1)The incidence of pregnancy complications,cesarean sections and perinatal adverse outcomes increased by ages.(2)Hierarchical statistics analysis of age showed that the incidence of hypertensive disease,gestational diabetes,uterine fibroids,neonatal asphyxia risk,and spontaneous delivery rate decreased in older women over 40 years of age.(3)For women over 35 years old,especially those over 40,we should do a good job in patient education.Prenatal health care and monitoring should be strengthened so as to prevent the occurrence of adverse pregnancy outcomes,and ensure the safety of both mothers and infants. |
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