未足月胎膜早破449例临床分析

Clinical analysis on 449 cases of preterm premature rupture of membranes

目的探讨未足月胎膜早破（preterm premature rupture of membranes，pPROM）的发病规律，分析pPROM患者不同孕周对分娩方式及围产儿结局的影响。方法对2003年1月至2007年12月间郑州大学第三附属医院的449例pPROM患者的临床资料进行回顾性分析。结果胎膜早破的发生率为14．3％，而pPROM发生率为3．3％；pPROM相关因素的构成比中，流产、引产史最高41．0％，其次为不明原因23．8％o、多胎10．4％及感染史9．8％；在分娩的437例pPROM患者中，孕32-34^＋6周组的剖宫产率高于孕28-31^＋6周组和孕35-36^＋6周组（P=0．001）；而孕28-31^＋6周组与孕35-36^＋6周组比较，无统计学意义（P=0．78）；490例围生儿中，孕32-34^＋6周组不同分娩方式对围生儿结局比较，无统计学意义（P〉0．0166），孕28～31^＋6周组、孕32-34^＋6周组的转PICU率、新生儿窒息率及低体重儿率均高于孕35-36^＋6周组，差异有统计学意义（P=0．001）。结论流产、引产史、感染及不明原因是pPROM发生的主要影响因素；剖宫产并不是降低围生儿不良结局的最佳分娩方式；围生儿结局与孕周密切相关。

Objective To explore the characters of preterm premature rupture of membranes （pPROM）, and analyze the influence of different gestational weeks of pPROM on the delivery route and perinatal outcomes. Methods A retrospective study of 449 cases of pPROM in the hospital from Jan. 2003 to Dec. 2007 was conducted. Results The prevalence of PROM among all pregnant women was 14. 3%, while pPROM was 3.3%. The correlative factors occurred in the 449 cases of pPROM as the following proportion： abortion and induced abortion for 41.0%, uncertained reasons 23.8%, multiple pregnancy 10. 4%, history of infection 9.8%. Among the 437 cases of delivered pPROM, the cesarean section rate in 32-34^＋6 gestational week group was higher than that in the 28- 31^＋6 week or 35-36^＋6 week group （P〈0. 0166）, while 28-31^＋6 week group presented no difference from that in the 35-36^＋6 week group （P〉0. 0166）. Among 490 newborns, delivery routes had no different effect on the newborn outcome in the 32-34^＋6 gestational week group. The transfer rate to PICU, the incident of neonatal asphyxia and low body weight in the 28--31^＋6 gestational week or 32--34^＋6 gestational week groups were higher than that in the 35-36^＋6 gestational week group （P〈0. 0166）. Conclusions The history of abortion and induced abortion, infection, uncertained reasons may be the major related factors of pPROM. Cesarean delivered is not the optimal delivery route to improve newborn outcomes. Newborn outcomes are associated to gestational weeks.