| Background and objective:With the opening of China's comprehensive two-child policy,the development of assisted reproduction in recent years,the incidence of preterm delivery remains high.It has been reported that the incidence of preterm delivery in China is 7%-15%,and that in developed countries such as Europe is 6%-11%.According to literature reports,about 10%of babies are born prematurely in the United States[1].The organ development of premature infants is immature and prone to very serious complications,so it is very important to identify the high risk factors of preterm delivery early,so as to screen the pregnant women with high risk of preterm delivery and take timely intervention to reduce the premature birth rate.This paper makes a retrospective analysis and study on the clinical data of 2550 cases of preterm delivery and 3001 cases of preterm infants delivered in the first Hospital of Jilin University from January 2016 to December 2019.To provide clinical reference for the prediction,diagnosis and treatment of preterm delivery,and to provide a basis for the diagnosis and treatment of premature infants,so as to reduce the occurrence of preterm delivery and the occurrence of adverse maternal and fetal outcomesResearch materials and methods:A retrospective analysis of preterm delivery in our hospital from January 2016 to December 2019,excluding induced labor due to fetal malformations and other personal reasons,a total of 2550 cases of premature delivery There were 3001 premature infants.500 pregnant women who gave full-term delivery in our hospital in the same period were randomly selected as the control group.Among the pregnant women with preterm delivery,there were 465 twins and 2085 singletons.There were 298 cases of IVF pregnancy and 2252 cases of natural pregnancy.Among the 2550 cases of preterm delivery,there were 685 cases of spontaneous preterm delivery,1012 cases of PPROM and 853 cases of therapeutic preterm delivery.Among the 685 cases of spontaneous preterm delivery,there were 41 cases of very early preterm delivery,132 cases of early preterm delivery,153 cases of moderate preterm delivery and 359 cases of mild preterm delivery.The general data,pregnancy history,pregnancy complications and complications,maternal laboratory examination,maternal and fetal outcome and short-term complications of premature infants were analyzed.1.The three groups of preterm delivery were compared with the control group,and the general condition,history of pregnancy and delivery,high risk factors,maternal and fetal outcome and laboratory indexes of pregnant women were compared.2.The general situation,pregnancy history,high risk factors and maternal fetal outcome of spontaneous preterm delivery in different gestational weeks were compared.3.The outcomes of preterm infants with three different causes were compared under the same gestational age.4.The birth status,recent complications and prognosis and outcome of premature infants with different gestational weeks were comparedSPSS 24.0 software was used for statistical analysis of the data,and the measurement data were tested for normality.Mean ±standard deviation was used for measurement data of normal distribution,and t-test or analysis of variance was used for comparison between groups.The measurement data of non-normal distribution were expressed by the median(P25-P75),rank sum test was used for comparison between groups.The counting data are expressed by frequency and rate,and the chi-square test is used for comparison between groups.If the expected number of four-grid data is less than 5,the Fisher's exact probability method is used to calculate the data P<0.05 was regarded as statistically significantResults:1.The proportion of preterm birth is decreasing year by year.The incidence of preterm delivery of twins and IVF increased year by year,The incidence of twin preterm delivery was significantly higher than that of singleton preterm delivery,and the incidence of IVF preterm delivery was significantly higher than that of natural pregnancy.Twin pregnancy and IVF pregnancy are prone to very early preterm delivery.Very early preterm delivery is mainly spontaneous preterm delivery,early preterm delivery is mainly spontaneous preterm delivery and PPROM,and mild preterm delivery is mainly therapeutic preterm delivery2.Age,multipara,irregular antenatal examination,IVF,twins,gestational diabetes and abnormal fetal position were independent risk factors for spontaneous preterm delivery.Age,twins,gestational gestational diabetes were independent risk factors for PPROM.Irregular antenatal examination,hypertensive disorder complicating pregnancy,placenta previa,scar uterus,twins,intrauterine infection,other infections,fetal distress,IUGR and ICP are independent risk factors for therapeutic preterm delivery3.The increase of the proportion of leukocytes and neutrophils and the decrease of total protein and albumin in pregnant women may be related to the occurrence of preterm delivery4.IVF,placental abruption,abnormal fetal position,intrauterine infection,cervical dysfunction and prenatal bleeding are the risk factors of very early and early spontaneous preterm delivery,while parturients,scar uterus and abnormal umbilical cord are the risk factors of mild spontaneous preterm delivery5.The cesarean section rate in the spontaneous preterm delivery group and PPROM group was lower than that in the control group,while that in the therapeutic preterm delivery group was higher than that in the control group.With the increase of gestational weeks,the cesarean section rate of spontaneous preterm delivery was gradually increasing.The incidence of postpartum hemorrhage in the therapeutic preterm delivery group was higher than that in the control group,and there was no significant difference in the incidence of spontaneous preterm postpartum hemorrhage among different gestational weeks6.The asphyxia rate and hospitalization days of therapeutic preterm infants were higher than those of spontaneous preterm delivery group and PPROM group7.With the increase of gestational weeks,the birth weight of spontaneous premature infants gradually increased,while the asphyxia rate,mortality rate,NICU conversion rate and NICU hospitalization days gradually decreased.The rate of asphyxia,the number of complications,the incidence of short-term complications and poor prognosis of preterm infants<32 weeks were significantly higher than those of preterm infants?32 weeks The birth weight of premature twins was lower than that of singletons,and the rate of NICU conversion was higher than that of singletons8.Among the very early and early premature infants,the top five recent complications of premature infants are patent ductus arteriosus,respiratory distress syndrome,neonatal anemia,neonatal intracranial hemorrhage and neonatal asphyxiaConclusion:1.With the application of assisted reproductive technology and the increase of twin pregnancy in recent years,the incidence of preterm delivery is high,and the prognosis of twin preterm infants is poor.For pregnant women with risk factors such as advanced age,previous history of preterm delivery,cervical insufficiency and other risk factors,iatrogenic twin pregnancy should be avoided as far as possible2.Preterm delivery is the result of the interaction of many risk factors In clinical work,patients with different risk factors of preterm delivery should be standardized diagnosis and treatment to reduce the occurrence of preterm delivery.3.Infection may play an important role in the occurrence and development of preterm delivery,and active prevention and treatment of infection can effectively reduce the premature birth rate4.In clinical work,under the condition of fully considering the fetal survival rate,combined with maternal condition and prognosis,an appropriate mode of delivery should be adopted5.Gestational age is the main factors related to the outcome of premature infants.Pregnant women whose gestational age is less than 32 weeks should actively protect the fetus on the premise of ensuring the safety of the mother and fetus.For pregnant women with gestational age?32 weeks,expectant therapy can be used on the basis of promoting fetal lung maturation. |
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