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[摘要] 目的 探讨二胎政策下高龄经产妇分娩巨大儿的相关因素及妊娠结局。方法 回顾性分析2015年10月— 2016年9月在郑州大学第三附属医院（以下简称“该院”） 分娩巨大儿（胎儿出生体重≥4 000 g）的112例高龄经产妇的分娩资料作为研究组， 并与同期分娩正常体重儿（2 500 g≤出生体重<4 000 g）的1 102例高龄经产妇的分娩资料作为对照组，比较两组临床资料及妊娠结局情况。结果 研究组分娩孕龄、产次、妊娠期糖尿病发生率分别为（39.27±1.03）周、（2.49±0.68）次、13.39%，明显高于对照组的（38.47±1.73）周、（2.18±0.48）次、6.17%；而研究组产检≥5次为72.32%，低于对照组的80.76%；研究组新生儿窒息、胎儿窘迫发生率，经阴道分娩者的总产程、产时及产后2 h出血量、羊水量均高于对照组；差异有统计学意义（P<0.05）。结论 二胎政策开放后，高龄经产妇增加，应加强对高龄经产妇的管理，针对其分娩巨大儿的高危因素，指导合理饮食，适当活动，控制体重增长过速，定时产检，降低巨大儿发生率，并选择合适分娩方式，改善母婴结局。

[关键词] 高龄；经产妇； 巨大儿；相关因素；妊娠结局

[中图分类号] R714 [文献标识码] A [文章编号] 1674-0742（2017）05（b）-0060-04

[Abstract] Objective To study the related factors and pregnant outcome of giant babies delivered by the elder primipara under the two children policy. Methods 112 cases of elder primipara giving birth to the giant babies （birth weight≥4 000 g） in our hospital from October 2015 to September 2016 were selected as the research group， while 1 102 cases of elder primipara giving birth to the normal-weight children（2 500 g≤birth weight<4 000 g） at the same period were selected as the control group， and the clinical data and pregnant outcome situation were compared between the two groups. Results The delivery pregnant age， parity and incidence rate of diabetes during the pregnancy period in the research group were obviously higher than those in the control group[（39.27±1.03）weeks， （2.49±0.68）times， 13.39% vs （38.47±1.73）weeks， （2.18±0.48）times， 6.17%]， but the antenatal care ≥5 in the research group was lower than that in the control group（72.32% vs 80.76%）， and the incidence rate of neonatal asphyxia and fetal distress， total labor course and labor time of vaginal delivery women and bleeding amount and amniotic fluid volume during 2 hours after labor in the research group were higher than those in the control group， and the differences between groups were statistically significant（P<0.05）. Conclusion After the release of two-children policy， the elder primipara increase， and we should enhance the management of elder primipara， guide the rational dieting according to the high-risk factors of giant babies， properly do some exercises， control the rapid weight increase， conduct the regular antenatal care， reduce the incidence rate of giant babies， select the proper delivery method and improve the maternal and infant outcome.

[Key words] Senile； Primipara； Giant baby； Related factors； Pregnant outcome

巨大兒（macrosomia）指胎儿体重达到或者超过4 000 g。目前欧美国家定义为胎儿体重达到或者超过4 500 g。巨大儿国内发生率约为7%，国外发生率为15.1%，男胎多于女胎[1]。随着我国二胎政策全面开放，高龄产妇及经产妇增多，以及近年来营养过剩致巨大儿的孕妇增多，巨大儿的发生率增加较快。近年来，在临床上运用各种方法来估计胎儿出生体重，但估计的准确性并不高，仍存在较大误差。然而高龄经产妇是巨大儿的高发人群，因此，有必要对高龄经产妇巨大儿的相关因素及对妊娠结局进行分析。该研究回顾性分析了2015年10月— 2016年9月在该住院分娩的112例巨大儿高龄经产妇的分娩资料，分析影响巨大儿的相关因素及其对妊娠结局的影响，现报道如下。

1 资料与方法

1.1 一般资料

方便收集在该院住院分娩的11 952例产妇资料，共分娩巨大儿（体重≥4 000 g）812例，发生率6.79%。高龄产妇1 880例， 分娩巨大儿140例（7.45%），其中体重≥4 500 g者（特大儿）14例，占巨大儿总数的10.00%；高龄经产妇1 473例，分娩巨大儿112例（7.60%）；高龄初产妇407例， 分娩巨大儿28例（6.88%）。选取112例分娩巨大儿的高龄经产妇作为研究组（高龄经产妇巨大儿组）；……