未足月妊娠胎膜早破147例分析

Clinical Analysis on 147 Cases of Preterm Premature Rupture of Membrane

目的:探讨未足月妊娠胎膜早破处理、分娩方式选择对母儿结局的影响。方法:回顾性分析147例妊娠28～36+6周胎膜早破妊娠妇女。按破膜时妊娠周分为:28～34+6妊娠周和35～36+6妊娠周2组。分析不同妊娠周的分娩方式和新生儿结局,破膜至分娩的时间与宫内感染的关系。结果:2组妊娠周剖宫产率差异无统计学意义(P>0.05);28～34+6周组新生儿发生各种并发症的比例明显高于35～36+6周组(P<0.01);新生儿出生体质量和Apgar评分明显低于35～36+6周组(P<0.01);新生儿治愈出院的时间明显长于35～36+6周组(P<0.01);破水≥48h分娩新生儿诊断宫内感染的比例明显高于破水48h内分娩者(P<0.01);妊娠35～36+6周组延长孕龄对新生儿结局无明显改善(P>0.05)。结论:妊娠28～34+6周发生胎膜早破在排除感染且最大羊水池深度>2cm者采取期待治疗,妊娠35～36+6周发生胎膜早破者考虑终止妊娠;无明确剖宫产指征时应选择阴道试产,出现产科指征和感染征象选择剖宫产。

Objective： To investigate the impacts of management and delivery methods for preterm premature rupture of membrane （PPROM） on the maternal and neonatal outcomes. Methods： The clinical data of 147 pregnant women who experienced PPROM during 28-36^＋6 weeks were analyzed retrospectively. These cases were divided into 2 groups according to the pregnancy weeks： the group of 28-34^＋6 weeks and the group of 35-36^＋6 weeks. The relationships between different delivery methods and neonatal outcomes, as well as between intrauterine infection and the time from membrane rupture to delivery were analyzed. Results： There were no significant differences of cesarean section rates between the 2 groups （P〉0.05）. The incidences of various neonatal complications in the 28-34^＋6 group were significantly higher than the 35-36^＋6 group （P〈0.01）, while the birth weights and Apgar scores were much lower than the 35-36^＋6 group （P〈0.01）. And the lasting time of neonates hospitalization in the 28-34^＋6 group was obviously longer than the 35-36^＋6 group （P〈0.01）. The proportion of intrauterine infection in cases with ≥48 h after PPROM was markedly higher than those within 48 h （P〈0.01）. Prolonged gestational age for the 35-36^＋6 group didn＇t lead to significant improvements in neonatal outcomes （P〉 0.05）. Conclusion： Expectant management is suitable for patients experienced PPROM during 28-34^＋6 weeks with the depth of amnitotic fluid 〉2 cm and no infections. Termination of pregnancy should be operated when PPROM happens during 35-36^＋6 weeks. Vaginal delivery should be selected if there are no definite cesarean section indications, while cesarean section should be performed with operative indications and infections.