妊娠晚期未足月胎膜早破208例临床分析

Preterm Premature Rupture of Membranes in Late Incomplete Pregnancy:Clinical Records of 208 Cases

目的探讨妊娠晚期未足月胎膜早破患者的治疗及妊娠结局。方法对2006年1月~2010年12月在河南省商丘市妇幼保健院住院分娩的208例妊娠晚期未足月胎膜早破患者的临床资料进行回顾性分析。结果生殖道炎症和胎位异常是胎膜早破发生的主要诱因,但大部分患者原因不明;妊娠晚期未足月胎膜早破患者经保胎治疗75.48%（157/208）的患者于48 h后分娩,为应用糖皮质激素促胎肺成熟争取了时间;25.48%（53/208）的患者以剖宫产结束妊娠,主要手术指征为骨盆因素及胎儿窘迫,因未足月胎儿相对较小,大部分患者可阴道分娩;胎龄28~31周的早产儿因发育不成熟等因素死亡率较高。结论妊娠晚期未足月胎膜早破的发生对孕产妇和围产儿的影响较大。胎膜早破与胎位异常、生殖道感染等关系密切,胎膜早破的分娩时机及分娩方式的选择原则上应根据胎儿所处危险的大小来决定,抗生素和糖皮质激素的应用可改善新生儿的结局。

Objective To study the treatment and the pregnancy outcome of patients with preterm premature rupture of membranes（PPROM）in late pregnancy.Methods The clinic data of 208 cases of PPROM in late pregnancy were retrospectively analyzed.Results The genital tract inflammation and abnormal fetal position were the major cause of PPROM,but most patients had unknown reasons.75.48% of the third trimester patients with PPROM（157/208）gave birth after 48 h,and were given glucocorticoids treatment to promote fetal lung maturation,25.48%（53/208）patients received cesarean section for termination of pregnancy.Most patients were subjected to vaginal delivery.The fetuses with 28 to 31 weeks gestational age had a higher mortality.Conclusion PPROM in the late pregnancy has a great impact on pregnant women and infants.Fetal anomalies and reproductive tract infections are closely related to PPROM.The delivery timing and mode of delivery are chosen in terms of the risk of the fetus.Antibiotics and corticosteroids can improve the neonatal outcome.