未足月胎膜早破的病因及妊娠结局分析
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摘要
目的探讨未足月胎膜早破的高危因素、临床处理及对母婴的影响。方法回顾性分析宁波市妇女儿童医院2017年1至12月收治的546例孕28～36~(+6)周胎膜早破患者的临床资料,分析未足月胎膜早破的高危因素及剖宫产指征,阴道分泌物培养情况。根据破膜时孕周分为A组(28～33~(+6)周)和B组(34～36~(+6)周),比较两组母婴结局的差异。结果生殖道感染是未足月胎膜早破的首要高危因素,瘢痕子宫是剖宫产指征的首要原因,解脲支原体是阴道分泌物培养中检出率最高的病原体。两组剖宫产、阴道顺产、阴道助产、急产、产褥感染、切口愈合不良的发生率比较差异均无统计学意义(均P>0.05);两组产后出血(χ~2=4.22)、胎盘早剥(χ~2=11.37)、宫内感染(χ~2=16.32)、胎盘绒毛膜羊膜炎(χ~2=23.47)、自然临产发生率(χ~2=6.47)及破膜至分娩时间(t=11.19)、住院时间(t=10.02)比较差异均有统计学意义(均P<0.05);两组新生儿呼吸窘迫综合征(χ~2=133.13)、新生儿窒息(χ~2=6.23)、新生儿肺炎(χ~2=93.80)、新生儿死亡(χ~2=6.24)的发生率及新生儿出生体重(t=-25.00)差异均有统计学意义(均P<0.05)。结论应重视高危因素,加强孕期保健,一旦确诊未足月胎膜早破,应积极采取治疗措施,适时终止妊娠,减少母婴并发症,保证母婴安全。
Objective To explore the risk factors, clinical treatment and the effect on mothers and neonates of preterm premature rupture of membranes(PPROM). Methods Clinical data of 546 cases of PPROM at 28 to 36~(+6) weeks' gestation from January to December 2017 in Ningbo Women and Children's Hospital were analyzed retrospectively. Risk factors, indications for cesarean section and culture of vaginal secretion for PPROM were studied. PPROM cases were divided into group A(28 to 33~(+6) weeks) and group B(34 to 36~(+6) weeks). Comparison of maternal and neonatal outcomes was made in two groups. Results Reproductive tract infection was the chief risk factor for PPROM. Scar uterus was the leading cause of cesarean section. Urealyticum ureaplasma was the pathogens with highest detection rate in the culture of vaginal secretion. There was no statistical difference in incidences of caesarean section, vaginal delivery, assisted vaginal delivery, partus precipitatus, puerperal infection, surgical wound bad healing(all P>0.05). The differences in postpartum hemorrhage(χ~2=4.22), placental abruption(χ~2=11.37), intrauterine infection(χ~2=16.32), placental chorioamnionitis(χ~2=23.47), natural labor incidence(χ~2=6.47), rupture of membranes to delivery(t=11.19) and hospitalization time(t=10.02) were statistically significant(all P<0.05). The differences were statistically significant in the incidences of respiratory distress syndrome of neonates(χ~2=133.13), neonatal asphyxia(χ~2=6.23), pneumonia of newborn(χ~2=93.80), neonatal death(χ~2=6.24) and neonatal birth weight(t=-25.00) between two groups(all P<0.05). Conclusion Risk factors for PPROM and antenatal care should be valued. Once PPROM is confirmed, active treatment measures should be taken. Timely termination of pregnancy is suggested to reduce the complications and ensure the safety of mothers and neonates.
Objective To explore the risk factors, clinical treatment and the effect on mothers and neonates of preterm premature rupture of membranes(PPROM). Methods Clinical data of 546 cases of PPROM at 28 to 36~(+6) weeks' gestation from January to December 2017 in Ningbo Women and Children's Hospital were analyzed retrospectively. Risk factors, indications for cesarean section and culture of vaginal secretion for PPROM were studied. PPROM cases were divided into group A(28 to 33~(+6) weeks) and group B(34 to 36~(+6) weeks). Comparison of maternal and neonatal outcomes was made in two groups. Results Reproductive tract infection was the chief risk factor for PPROM. Scar uterus was the leading cause of cesarean section. Urealyticum ureaplasma was the pathogens with highest detection rate in the culture of vaginal secretion. There was no statistical difference in incidences of caesarean section, vaginal delivery, assisted vaginal delivery, partus precipitatus, puerperal infection, surgical wound bad healing(all P>0.05). The differences in postpartum hemorrhage(χ~2=4.22), placental abruption(χ~2=11.37), intrauterine infection(χ~2=16.32), placental chorioamnionitis(χ~2=23.47), natural labor incidence(χ~2=6.47), rupture of membranes to delivery(t=11.19) and hospitalization time(t=10.02) were statistically significant(all P<0.05). The differences were statistically significant in the incidences of respiratory distress syndrome of neonates(χ~2=133.13), neonatal asphyxia(χ~2=6.23), pneumonia of newborn(χ~2=93.80), neonatal death(χ~2=6.24) and neonatal birth weight(t=-25.00) between two groups(all P<0.05). Conclusion Risk factors for PPROM and antenatal care should be valued. Once PPROM is confirmed, active treatment measures should be taken. Timely termination of pregnancy is suggested to reduce the complications and ensure the safety of mothers and neonates.
引文
[1]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013,133-135.
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[3]张晓华,高静,张惠珍,等.妇女孕期下生殖道微生态失衡及感染的临床分析[J].中国妇幼健康研究,2014,25(3):465-469.
[4]Dolgushin S A,Odintsova E S,Gerasimenko A Y,et al.Preliminary tests of multiplex immunoassay for detection of TORCH infections in human blood serum using flow cytometry[J].Biomed Eng,2015,49(2):85-89.
[5]彭兰,柴利强,陈大立,等.孕妇孕晚期GBS定植及新生儿早发型GBS感染趋势[J].中国妇幼健康研究,2016,27(1):26-28.
[6]荣蓉,万春花.胎膜早破与孕妇生殖道UU和CT感染的关系[J].中国妇幼健康研究,2013,24(6):99-901.
[7]Wang L,Chen L,Li R,et al.Efficacy of surfactant at different gestational ages for infants with respiratory distress syndrome [J].Int J Clin Exp Med,2015,8(8):13783-13789.
[8]Cordeiro C N,Althaus J,Burke A,et al.Herpes simplex virus cervicitis mimicking preterm premature rupture of membranes[J].Obstet Gynecol,2015,126(2):378-380.
[9]张素琼.273例未足月胎膜早破的临床分析[J]. 现代医院,2014,14(2):30-32.
[10]Kim C J,Romero R,Chaemsaithong P,et al.Acute chorioamnionitis and funisitis:definition, pathologic features,and clinical significance[J].Am J Obstet Gynecol,2015,213(4Suppl):S29-S52.
[11]Mitchell C M,Haick A,Nkwopara E,et al.Colonization of the uppergenital tract by vaginal bacterial species in non-pregnant women[J].Am J Obstet Gynecol,2015,212(5):611.e1-611.e9.
[12]Gasparovic V E,Ahmetasevic S G,Beljan P.The role of antibiotic prophylaxis in preterm premature rupture of membranes[J].Coll Antropol,2014,38(2):653-657.
[13]Eleje G U,Adinma J I,Ghasi S,et al.Antibiotic susceptibility pattern of genital tract bacteria in pregnant women with preterm premature rupture of membranes in a resource-limited setting[J].Int J Gynaecol Obstet,2014,127(1):10-14.
[14]]尹玲凤,丁虹娟.早产相关因素的临床分析[J].中国妇幼健康研究,2016,27(10):1234-1237.
[15]Menon R,Boldogh I,Hawkins H K,et al.Histological evidence of oxidative stress and premature senescence in preterm premature rupture of the human fetal membranes recapitulated in vitro[J].Am J Pathol,2014,184(6):1740-1751.
[16]Goya M,Bernabeu A,Garcia N,et al.Premature rupture of membranes before 34 weeks managed expectantly:maternal and perinatal outcomes in singletons[J].J Matern Fetal Neonatal Med,2013,26(3):290-293.
[17]王君莲,孙江川,常淑芳,等.未足月胎膜早破的治疗进展[J].重庆医学,2014,43(15):1951-1953.
[18]袁丽君.早产合并胎膜早破的原因分析及临床诊断[J].转化医学电子志,2014,16(6):85-86.
[19]American College of Obstetricians and Gynecologists.Practice Bulletin No.139:premature rupture of membranes.Clinical management guidelines for obstetrician-gynecologists[J]. Obstet Gynecol,2013,122(4):918-930.
[20]中华医学会妇产科学分会产科学组.胎膜早破的诊断与处理指南(2015)[J].中华妇产科杂志,2015,50(1):3-8.
[2]Ekin A,Gezer C,Taner C E,et al.Risk factors and perinatal outcomes associated with latency in preterm premature rupture of membranes between 24 and 34 weeks of gestation[J].Arch Gynecol Obstet,2014,290(3):449-455.
[3]张晓华,高静,张惠珍,等.妇女孕期下生殖道微生态失衡及感染的临床分析[J].中国妇幼健康研究,2014,25(3):465-469.
[4]Dolgushin S A,Odintsova E S,Gerasimenko A Y,et al.Preliminary tests of multiplex immunoassay for detection of TORCH infections in human blood serum using flow cytometry[J].Biomed Eng,2015,49(2):85-89.
[5]彭兰,柴利强,陈大立,等.孕妇孕晚期GBS定植及新生儿早发型GBS感染趋势[J].中国妇幼健康研究,2016,27(1):26-28.
[6]荣蓉,万春花.胎膜早破与孕妇生殖道UU和CT感染的关系[J].中国妇幼健康研究,2013,24(6):99-901.
[7]Wang L,Chen L,Li R,et al.Efficacy of surfactant at different gestational ages for infants with respiratory distress syndrome [J].Int J Clin Exp Med,2015,8(8):13783-13789.
[8]Cordeiro C N,Althaus J,Burke A,et al.Herpes simplex virus cervicitis mimicking preterm premature rupture of membranes[J].Obstet Gynecol,2015,126(2):378-380.
[9]张素琼.273例未足月胎膜早破的临床分析[J]. 现代医院,2014,14(2):30-32.
[10]Kim C J,Romero R,Chaemsaithong P,et al.Acute chorioamnionitis and funisitis:definition, pathologic features,and clinical significance[J].Am J Obstet Gynecol,2015,213(4Suppl):S29-S52.
[11]Mitchell C M,Haick A,Nkwopara E,et al.Colonization of the uppergenital tract by vaginal bacterial species in non-pregnant women[J].Am J Obstet Gynecol,2015,212(5):611.e1-611.e9.
[12]Gasparovic V E,Ahmetasevic S G,Beljan P.The role of antibiotic prophylaxis in preterm premature rupture of membranes[J].Coll Antropol,2014,38(2):653-657.
[13]Eleje G U,Adinma J I,Ghasi S,et al.Antibiotic susceptibility pattern of genital tract bacteria in pregnant women with preterm premature rupture of membranes in a resource-limited setting[J].Int J Gynaecol Obstet,2014,127(1):10-14.
[14]]尹玲凤,丁虹娟.早产相关因素的临床分析[J].中国妇幼健康研究,2016,27(10):1234-1237.
[15]Menon R,Boldogh I,Hawkins H K,et al.Histological evidence of oxidative stress and premature senescence in preterm premature rupture of the human fetal membranes recapitulated in vitro[J].Am J Pathol,2014,184(6):1740-1751.
[16]Goya M,Bernabeu A,Garcia N,et al.Premature rupture of membranes before 34 weeks managed expectantly:maternal and perinatal outcomes in singletons[J].J Matern Fetal Neonatal Med,2013,26(3):290-293.
[17]王君莲,孙江川,常淑芳,等.未足月胎膜早破的治疗进展[J].重庆医学,2014,43(15):1951-1953.
[18]袁丽君.早产合并胎膜早破的原因分析及临床诊断[J].转化医学电子志,2014,16(6):85-86.
[19]American College of Obstetricians and Gynecologists.Practice Bulletin No.139:premature rupture of membranes.Clinical management guidelines for obstetrician-gynecologists[J]. Obstet Gynecol,2013,122(4):918-930.
[20]中华医学会妇产科学分会产科学组.胎膜早破的诊断与处理指南(2015)[J].中华妇产科杂志,2015,50(1):3-8.