未足月胎膜早破期待治疗妊娠结局的多因素分析

Multivariate analysis on pregnancy outcomes of neonates with preterm premature rupture of membranes after expectant management

目的:探讨未足月胎膜早破(PPROM)期待治疗中母儿不良妊娠结局的独立危险因素。方法:回顾性分析132例PPROM孕妇的临床资料,按照有无孕妇及新生儿严重并发症(包括新生儿死亡)的发生分别分为孕妇不良妊娠结局组与对照组和新生儿不良结局组与对照组,分别比较两组患者的一般临床情况及各项检验指标。采用多因素Logistic回归分析母儿不良妊娠结局的危险因素。结果:132例期待治疗中,34例孕妇出现严重并发症,发生率为25.8%(34/132),无孕产妇死亡。胎死宫内4例,47例新生儿出现明显并发症,其中8例新生儿死亡,围产儿死亡率为5.8%(8/138)。经多因素回归分析,就诊时间(以2h为界)及感染是孕妇严重并发症发生的独立危险因素,分娩孕周、就诊时间及感染是新生儿病率及死亡率的独立危险因素。结论:PPROM期待治疗过程需严密监测及预防感染,孕周小者适当延长孕周;在2h内就诊,预防性使用抗生素及促胎肺成熟,可减少孕产妇感染及围生儿病死率。

Objective：To explore the independent risk factors of adverse pregnancy outcomes of mothers and neonates during expectant management of neonates with preterm premature rupture of membranes （PPROM）.Methods：The clinical data of 132 pregnant women with PPROM were analyzed retrospectively,then the cases were divided into maternal adverse pregnancy outcomes group and control group,neonatal adverse pregnancy outcomes group and control group according to severe complications of pregnant women and neonates （including neonatal death） or not,then general clinical conditions and test indexes in the two groups were compared; the risk factors of adverse pregnancy outcomes of mothers and neonates were analyzed by logistic regression analysis.Results：Among 132 pregnant women,34 pregnant women were found with severe complications,the incidence was 25.8% （34/132）,no maternal death occurred; intrauterine fetal death was found in 4 cases; 47 neonates were found with obvious complications,8 neonates died,the perinatal mortality was 5.8% （8/138）; after multivariate regression analysis,visiting time （within two hours） and infection were independent risk factors of adverse pregnancy outcomes of pregnant women,delivery pregnancy week,visiting time and infection were independent risk factors of perinatal morbidity and mortality.Conclusion：During the course of expectant management,comprehensive monitoring,prevention of infection and appropriate extension of small gestational age are necessary,consulting within two hours,using antibiotics for preventing infection and promoting fetal lung maturation can reduce maternal infection and perinatal mortality.