早产临床风险因素的探讨

Study on the clinical risk factors of preterm labor

目的评估影响早产分娩的风险因素以及对早产干预措施影响的相关因素。方法选择2003年1月至2006年3月发生在34周前的自发性早产临产、早产胎膜早破、宫颈机能不全、先兆早产4种临床表现类型共221例,比较4种临床表现之间发病的风险因素及影响干预措施结局的相关因素。结果自发性早产临产的风险因素依次为:本次妊娠先兆流产史(OR8.917,95%CI2.308～34.457)、胎次(OR2.179,95%CI1.033～4.598)、宫颈长度改变(OR0.366,95%CI0.259～0.518);早产胎膜早破的风险因素依次为:自然流产史(OR4.922,95%CI1.115～21.720)、体外受精-胚胎移植(IVF-ET)(OR5.341,95%CI1.571～18.164);宫颈功能不全的风险因素依次为:早产史(OR9.010,95%CI2.032～39.940),IVF-ET(OR2.603,95%CI1.195～5.670)。发生早期早产分娩的影响因素依次为:血象升高(OR4.695,95%CI2.065～10.671)、宫颈长度变短(OR0.633,95%CI0.456～0.880)。对早产干预措施的影响因素为紧急宫颈环扎术(OR26.372,95%CI2.770～251.085)和血象升高(OR7.111,95%CI1.769～28.53)。结论影响早产的风险因素较多,应注重IVF-ET妊娠的早产风险;实施紧急宫颈环扎术及注重感染指标监测是减少34周前分娩的重要干预手段。

Objective To identify the high risk factors associated with early spontaneous preterm birth and explore contributing factors affected the means of intervention on preterm labor. Methods Two hundred and twenty-one cases with spontaneous preterm labor （sPTL）, preterm premature rupture of membranes （PPROM）, cervical incompetence （CI） and threatened premature labor（TPL） were enrolled in this study which onset before 34 gestational weeks. Risk factors were evaluated statistically. Results Risk factors of sPTL was associated with a history of threatened abortion at index pregnancy （ OR 8. 917,95% CI 2. 308-34.457 ）, multiple pregnancies （ OR 2. 179,95% CI 1. 033 - 4. 598）, cervical length change（ OR 0.366,95% CI 0. 259 - 0.518 ）. Risk factors for PPROM were history of spontaneous abortion（ OR4.922, 95% CI 1.115 - 21. 720） and IVF - ET（ ORS. 341,95% CI 1. 571 - 18. 164）. Risk factors for CI were a history of previous preterm delivery （ OR9.010,95% C I 2. 032 -39. 940） and IVF - ET （ OR 2. 603,95 % CI 1.195 ~ 5. 670）. Risk factors for early spontaneous preterm delivery were elevated leukocyte count（ OR 4.695,95% CI 2. 065 - 10. 671 ） and cervi- cal length change（OR 0.633,95% CI 0. 456 -0. 880）. The affected factors on intervention means of preterm delivery were emergency cervical cerclage（ OR 26. 372,95% CI 2. 770 - 251. 085 ） and elevated leukocyte count（ OR 7.111,95% CI 1. 769 - 28.53）. Conclusions Multiple factors contribute to preterm labor. IVF - ET should be considered as one of the risk factors of preterm birth. Elevated leukocyte count is associated with delivery before 34 gestational - weeks. A performance of emergency cervical cerclage and infection monitoring are essential approaches for delaying of preterm delivery before 34-week.