| Objective:To explore the correlation analysis of pregnancy complications,pregnancy outcomes and perinatal outcomes among pregnant women of different ages,focusing on the correlation between advanced maternal age and multiple pregnancy outcomes,to further analyze the risk factors related to postpartum hemorrhage in advanced maternal age,and provide a clinical basis for assessing the risk of pregnancy and childbirth in advanced maternal age.Methods:In this study,6462 pregnant women who delivered in the Second Affiliated Hospital of Soochow University from 01/2019 to 12/2021 and met the inclusion criteria were selected as the study population and were divided into three groups according to the actual age at delivery,they were divided into three groups: 20-29 years old group(3287 cases),30-34 years old group(2414 cases),and ≥35 years old group(761 cases).Retrospective analysis was used to collect age,height,pre-pregnancy weight,gestational weight gain,gravida,parity,mode of conception,recurrent miscarriage,gestational age,mode of delivery,indications for cesarean section,postpartum hemorrhage,and neonatal weight,neonatal asphyxia,neonatal admission to NICU,gestational diabetes mellitus,hypertensive disorders of pregnancy,hypothyroidism,premature rupture of fetal membranes,intrahepatic cholestasis of pregnancy,fetal growth restriction,oligohydramnios,amniotic fluid Excessive,placenta previa,placental abruption,placental adhesions,placenta accreta,and pregnancy with uterine fibroids,and collect prenatal blood routine,coagulation,blood lipid indexes,including hemoglobin(Hb),platelet(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fiber Proprotein(FIB)and D-dimer(DD),as well as total cholesterol(TC),triglyceride(TG).SPSS 22.0 was used for statistical analysis,and the univariate method was used to analyze all variables to obtain the correlation between different delivery ages and pregnancy complications,pregnancy outcomes and perinatal outcomes,and to further study the risk factors of postpartum hemorrhage in advanced maternal age(≥35 years old group),multivariate two Categorical Logistic regression analysis,and finally obtained the independent risk factors of postpartum hemorrhage in advanced maternal age.Results:1.The trend of the total number of deliveries in three years and the distribution of mothers of different ages: From 2019 to 2021,the total number of deliveries per year in our hospital showed a downward trend.In 2019(2650 cases),2020(2033 cases)and 2021(1779 cases),in which the total number of mothers in all age groups showed a downward trend over the three years.In different years,the proportion of the total number of puerperae in the 24-29-year-old group to the total number of childbirths in that year showed an obvious downward trend year by year,while the proportion of the total number of puerperae in the ≥35-year-old group to the total number of childbirths in the year showed an increasing trend year by year,but the upward trend was not obvious.2.There were significant differences among the three age groups in terms of pregnancy,parity,gestational age,scarred uterus,pregnancy with uterine fibroids,assisted reproductive technology conception,and recurrent miscarriage(P < 0.05).The24-29-year-old group was lower than the 30-34-year-old group and the ≥35-year-old group in terms of pregnancy,parity,scarred uterus,pregnancy with uterine fibroids,assisted reproductive technology conception,and recurrent miscarriage,and the scarred uterus in the ≥35-year-old group,he incidence of pregnancy complicated with uterine fibroids is higher.3.Three age groups had significant differences in pregnancy complications:gestational diabetes mellitus,gestational hypertension,intrauterine growth restriction and placenta previa among the three age groups(P<0.05).The ≥35-year-old group had the highest incidence of gestational diabetes mellitus,gestational hypertension and placenta previa,and the lowest incidence of fetal growth restriction.4.There were significant differences among the three age groups in delivery outcomes:cesarean section,episiotomy,postpartum hemorrhage,placental adhesions,and placenta accreta(P < 0.05).The incidences of cesarean section,postpartum hemorrhage,and placenta accreta were highest in the ≥35-year-old group,while the incidence of placental adhesions was highest in the 30-34-year-old group.5.There were differences in the indications of cesarean section between primipara and multiparous women among the three age groups(P<0.05).Signs are mainly scarred uterus.6.There were differences in the perinatal outcomes: fetal distress and neonatal asphyxia among the three age groups(P < 0.05).The incidence of fetal distress and neonatal asphyxia in the 20-29-year-old group was the highest,while the disease incidence in the ≥35-year-old group was the lowest.7.The prenatal APTT,D-D,and triglyceride levels in the 30-34-year-old group and the ≥35-year-old group were higher than those in the 24-29-year-old group,and the prenatal APTT,PT,and D-D levels in the ≥35-year-old group were the highest,and the antenatal APTT,PT,and D-D levels were the highest in the 30-34-year-old group.The prenatal FIB,Hb,PLT,and total cholesterol levels of the age group and the ≥35-year-old group were lower than those of the 24-29-year-old group,and the prenatal FIB level of the≥35-year-old group was the lowest,and the difference was statistically significant(P<0.05).8.The independent influencing factors of postpartum hemorrhage in advanced maternal age include: gestational age(OR=0.586,95%CI: 0.315-1.091),placental adhesion(OR=4.216,95%CI: 1.462-12.162),placenta accreta(OR=7.855,95%CI: 1.44-42.834),FIB(OR=0.584,95%CI: 0.364-0.937),D-D(OR=1.508,95%CI: 1.144-1.988),the difference was statistically significant(P<0.05).9.In advanced maternal age,the prenatal plasma FIB level decreases and the D-D level increases,and the risk of postpartum hemorrhage increases.Conclusion:1.There are significant differences in pregnancy complications,pregnancy outcomes and perinatal outcomes among pregnant women of different ages.2.Advanced maternal age is closely related to the occurrence of adverse pregnancy outcomes.Advanced age increases the incidence of assisted reproductive technology conception,pregnancy with uterine fibroids,gestational diabetes mellitus,gestational hypertension,placenta previa,and fetal growth restriction.It increases the risk of adverse pregnancy outcomes including of cesarean section,postpartum hemorrhage,and placenta accreta.3.The independent risk factors of postpartum hemorrhage in advanced maternal age include placental adhesion,placenta accreta,decrease of prenatal FIB level and increase of D-D level.The gestational age of delivery in advanced puerperium is closely related to the occurrence of postpartum hemorrhage. |
