Adolescent pregnancy outcomes in minority areas / 中华围产医学杂志

Objective:To analyze the pregnancy complications and outcomes in adolescent women in minority areas in China and the factors affecting the pregnancy outcomes.Methods:This retrospective study enrolled 697 singleton pregnant women who were younger than 20 years old and delivered at Sanjiang Dong Autonomous County People's Hospital of Liuzhou City from January 1, 2014, to December 31, 2018, as the case group. Meanwhile, 2 592 cases aged between 20 to 25 years and delivered during the same period were selected as the control group in an allocation ratio of 1∶4. Chi-square test, t test and binary logistic regression were used for comparing the differences of general characteristics, pregnancy complications, comorbidities and pregnancy outcomes between the two groups. Results:(1) The body mass index before delivery of the case group was lower than that of the control group [(24.7±3.4) vs (25.1±3.1) kg/m 2, t=－2.062, P=0.039]. The proportion of Dong minority was accounted for 48.06%(335/697) in the case group and 52.04%(1 349/2 592) in the control group. The proportion of women with junior school education or lower was higher in the case group than that in the control group [95.41% (665/697) vs 90.27% (2 340/2 592), χ2=45.086, P<0.001]. (2) The case group was noted for higher incidence of anemia [24.25% (169/697) vs 15.20% (394/2 592), χ2=31.683], premature delivery [7.17% (50/697) vs 4.55% (118/2 592), χ2=7.786], premature rupture of membranes [13.34% (93/697) vs 9.10% (237/2 592), χ2=10.731] and oligohydramnios [9.76% (68/697) vs 7.02% (182/2 592), χ2=5.848] than the control group (all P<0.05). (3) The incidence of cesarean section [27.26% (190/697) vs 38.04% (986/2 592), χ2=27.791, P<0.001] and the neonatal birth weight [(3 047.29±453.46) vs (3 131.01±472.44) g, t=－4.188, P<0.001] in the case group were lower, but the incidence of episiotomy [40.17% (280/697) vs 8.72% (226/2 592)] and the proportion of neonatal intensive care unit admission[10.76% (75/697) vs 3.82% (99/2 592)] were higher when comparing to the control group ( χ2=417.439 and 52.816, both P<0.001). (4) Multivariate binary logistic regression analysis showed that the risk of cesarean section ( aOR=0.62, 95% CI: 0.51-0.75) was reduced in adolescent women, but the risks of episiotomy ( aOR=6.20, 95% CI: 4.99-7.71) and neonatal intensive care unit admission ( aOR=2.68, 95% CI: 1.92-3.75) increased. Conclusions:Most of the pregnant adolescents are less-educated and ethnic minorities in this study, among which the Dong minority was predominant. Adolescent pregnancies are at a higher risk of anemia, preterm birth and premature rupture of membranes. Therefore, enhanced perinatal management of adolescent pregnancy is recommended to reduce adverse pregnancy outcome.

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Relationship between the risk of emergency cesarean section for nullipara with the prepregnancy body mass index or gestational weight gain / 中华妇产科杂志

Objective To investigate the risk of emergency cesarean section during labor with the pre-pregnancy body mass index or gestational weight gain.Methods A total of 6 908 healthy nullipara with singleton pregnancy and cephalic presentation who was in term labor in Beijing Obstetrics and Gynecology Hospital from August 1st,2014 to September 30th,2015 were recruited.They were divided into two groups,the vaginal delivery group (92.88％,6 416/6 908) and the emergency cesarean section group (7.12％,492/6 908).According to WHO body mass index (BMI) classification criteria and the pre-pregnancy BMI,the 6 908 women were divided into three groups,the underweight group(BMI＜18.5 kg/m2;17.39％,1 201/6 908),the normal weight group(18.5-24.9 kg/m2;73.00％,5 043/6 908),the overweight and obese group (≥ 25.0 kg/m2;9.61％,664/6 908).According to the guidelines of Institute of Medicine (IOM),they were divided into three groups,the inadequate gestational weight gain (GWG) group (16.72％,1 155/6 908),the appropriate GWG group (43.11％,2 978/6 908),the excessive GWG group (40.17％,2 775/6 908).Unadjusted and adjusted odds ratio (OR) and confidence interval (CI) of the risk of emergency cesarean section were calculated by bivariate logistic regression.Results (1) Comparing to the vaginal delivery group,women in the emergency cesarean section group were older,with a lower education level.Their prepregnancy BMI was higer and had more gestational weight gain.They had higher morbidity of pregnancy induced hypertension and gestational diabetes mellitus.Comparing to the vaginal delivery group,the neonates in the emergency cesarean section group were elder in gestational week,with higher birth weight.More male infants and large for gestation age infants were seen in the emergency cesarean section group (all P ＜ 0.05).(2) Overweight and obesity were associated with the increased risk of emergency cesarean section for nullipara,with the unadjusted OR of 1.98 (95％CI:1.54-2.54),adjusted OR(aOR) of 1.66 (95％CI:1.27-2.16).In the inadequate GWG group and the excessive GWG group,overweight and obese women had increased risk of emergency cesarean section,with adjusted OR of 2.33 (95％CI:1.06-5.14) and 1.62 (95％CI:1.44-2.28),respectively.In the appropriate GWG group,there was no significant difference in the risk of emergency cesarean section between the overweight and obese women and the normal weight women,with aOR of 1.54 (95％CI:0.94-2.54).The underweight group was associated with decreased risk of emergency cesarean section (OR=0.55,95％CI:0.40-0.74;aOR=0.66,95％ CI:0.48-0.90).While no significant difference in the risk of emergency cesarean section was found between the underweight women,the overweight and obese women,with the aOR of 0.31 (95％CI:0.07-1.32),0.73 (95％CI:0.48-1.10),0.66 (95％CI:0.38-1.12),respectively.(3) Absolute value of gestational weight gain was associated with the increased risk of emergency cesarean section,(aOR=1.03,95％CI:1.01-1.05).GWG above IOM giudelines did not independently affect the risk of emergency cesarean section (OR=1.30,95％CI:1.07-1.58;aOR=1.01,95％CI:0.82-1.24).In the underweight group,the normal weight group and the overweight or obese group,the excessive GWG women and the appropriate GWG women had no significant difference in the risk of emergency cesarean section (aOR=1.03,95％CI:0.55-1.12;aOR=1.02,95％CI:0.80-1.30;aOR=1.03,95％ CI:0.59-1.78),respectively.GWG below IOM giudelines was associated with decreased risk of emergency cesarean section (OR=0.62,95％ CI:0.45-0.85;aOR=0.64,95％ CI:0.46-0.88).In the underweight group and the overweight or obese group,there was no significant difference in the emergency cesarean section risk between the inadequate GWG women and the appropriate GWG within women (aOR=0.24,95％CI:0.06-1.01;aOR=0.90,95％CI:0.40-2.04).In the normal weight group,the inadequate GWG women had lower risk of emergency cesarean section (aOR=0.65,95％ CI:0.45-0.95).Conclusions Overweight and obese women have increased risk of emergency cesarean section.The prepregnancy BMI is supposed to be an appropriate level.Absolute value of gestational weight gain is associated with increased risk of emergency cesarean section.There is no correlation between the excessive GWG and the risk of emergency cesarean section.

Duration of second stage and maternal and neonatal outcomes in high risk gravidas populations after application of new partogram / 中华围产医学杂志

Objective To investigate the association between the duration of second stage of labor and maternal and neonatal outcomes in pregnant women complicated with hypertensive disorders,dysglycaemia (including gestational diabetes mellitus and diabetes mellitus complicating pregnancy) or primipara-inadvanced-age,and in normal pregnant women after implementation of new partogram.Methods A retrospective analysis was performed on all nulliparous women with the duration of second stage of labor ≥2 h at Beijing Obstetrics and Gynecology Hospital,Capital Medical University between October 1,2014 and March 31,2015.Women with preterm labor,multiple gestation,noncephalic presentations,fetal malformations,placenta previa,or induction of labor after fetal death were excluded.And 279 women who met the inclusion criteria served as study group.Among the 279 women,25 had hypertensive disorders (hypertension group),46 had dysglycaemia (dysglycaemia group),and 35 had primipara-in-advanced-age (primipara-in-advanced-age group),and the remaining 177 women served as ordinary study group.According to the duration of second stage,the ordinary study group was divided into three subgroups:≥ 2-＜2.5 h (n=90),≥ 2.5-＜3 h (n=51),and ≥ 3 h(n=36).And 340 women with the duration ＜ 2 h were selected randomly as control group,including 24 with hypertensive disorders (hypertension control group),61 with dysglycaemia (dysglycaemia control group),and 41 with primipara-in-advanced-age (primipara-in-advanced-age control group);the remaining 226 women served as ordinary control group.Maternal and neonatal outcomes in these two groups were analyzed with Rank sum test,Chi-square test or Fisher's exact test.Results (1) Dysglycaemia group had a longer first stage of labor,lower rate of spontaneous labor and higher rate of forcep-assisted delivery than its counterpart control group [11.88(8.42-16.06) vs 8.17(5.00 14.12) h,67.4％(31/46) vs 91.8％(56/61),and 30.4％(14/46) vs 8.2％(5/61),respectively,all P＜0.05].Primipara-in-advanced-age group had a longer first stage of labor,higher intervention rate,lower spontaneous labor rate and higher rate of forcep-assisted delivery than its counterpart control group [12.33(7.17-20.50) vs 7.50(4.00-15.12) h,61.8％(21/34) vs 36.6％(15/41),60.0％(21/35) vs 90.2％(37/41),and 34.3％(12/35) vs 9.8％(4/41),respectively,P＜0.05].Compared with ordinary control group,women in the ordinary study group,≥ 2-＜2.5 h,≥ 2.5-＜3 h and ＞3 h subgroup had a longer first stage of labor,higher labor intervention rate,and lower spontaneous labor rate (all P＜0.05).Ordinary study group and ≥ 3 h subgroup had higher rates of labor analgesia and forcep-assisted delivery than the ordinary control group.The forcepassisted delivery rate in ≥ 2.5-＜3 h subgroup and cesarean section rate in ≥ 3 h subgroup were all higher than in ordinary control group (P＜0.05).(2) Hypertension group had a higher incidence of postpartum hemorrhage than its corresponding control group while primipara-in-advanced-age group had a higher incidence [48.0％(12/25)vs 20.8％(5/24),and 34.3％(12/35) vs 7.3％(3/41),both P＜0.05).Ordinary study group,≥ 2.5-＜3 h subgroup and ≥ 3 h subgroup had higher rates of postpartum hemorrhage and adverse wound healing than the ordinary control group (all P＜0.05).(3) Compared with ordinary control group,≥ 2-＜2.5 h subgroup had a higher rate of neonatal asphyxia,≥ 2.5-＜3 h subgroup had higher fetal macrosomia proportion,and ≥ 3 h subgroup had a higher rate of admission to neonatal intensive care unit (all P＜0.05).In ordinary study group,6(3.4％) out of the 177 cases had neonatal asphyxia,all in the ≥ 2-＜2.5 h subgroup [6.7％(6/90)],which was higher than in the ordinary control group [0.9％ (2/226)],P＜0.05.Conclusions With the prolonged duration of the second stage,the risk of adverse matemal and neonatal outcomes increases.For pregnant women complicated with hypertensive disorders,dysglycaemia or primipara-in-advanced-age,the duration of the second stage of should not be prolonged.