足月及近足月胎膜早破计划分娩时机的探讨

Study on the opportunity of programed delivery for full-term and near-term premature rupture of membrane

目的:探讨足月及近足月胎膜早破孕妇不同计划分娩时机对分娩方式和母婴并发症的影响。方法:对852例足月及近足月(孕周≥35周)、单胎头位且无其他合并症的胎膜早破孕妇的临床资料进行回顾性分析。按自然临产和计划分娩干预时间不同分为4组:A组为破膜12 h内自然临产424例,B组为破膜12～24 h自然临产146例,C组为期待至12 h未临产行缩宫素计划分娩131例,D组为破膜期待至24 h未临产行缩宫素计划分娩151例。比较各组孕妇的分娩方式及母婴并发症。结果:①A、B、C、D组剖宫产率分别为8.96%、8.90%、25.95%、27.15%,C、D组剖宫产率均高于A、B组差异有统计学意义(P<0.05),D、C组剖宫产率比较差异无统计学意义(P>0.05)。②D组宫内感染率(17.21%)、产褥病率(15.23%)、围产儿病率(21.85%)均高于A(0.94%、1.41%、4.09%)、B(2.84%、2.73%、5.47%)和C组(5.34%、5.50%、7.60%),差异有统计学意义(P<0.01),产后出血率各组之间比较差异无统计学意义(P>0.05)。结论:在足月及近足月胎膜早破孕妇中,破膜<12 h以期待为主,破膜12～24 h未能自然临产者应积极计划分娩,以降低剖宫产及母婴并发症的发生率。

Objective： To explore the effects of different opportunities of programed delivery for the pregnant women with full - term and near - term premature rupture of membrane （PROM） on delivery modes and maternal and infantile complications. Methods： The clinical data of 852 full- term or near-term pregnant women （gestational weeks ≥35 weeks, single pregnancy, head position, within other complications） with PROM were analyzed retrospectively. They were divided into four groups according to different interventional opportunities of spontaneous labor and programed delivery ： 424 cases of spontaneous labor within 12 hours after PROM （ group A）, 146 cases of spon- taneous labor at 12 -24 hours after PROM （group B） , 131 cases of programed delivery with oxytocin at 12 hours after PROM, and 151 cases of programed delivery with oxytocin at 24 hours after PROM. The delivery modes and maternal and infantile complications in the four groups were compared. Results： The cesarean section rates in group A, group B, group C, and group D were 8.96%, 8.90%, 25.95%, and 27.15% , respectively; the cesarean section rates in group C and group D were statistically significantly higher than those in group A and group B （ P 〈 0. 05 ）, but there was no statistically significant difference between group C and group D （ P 〉 0.05 ） . The intrauterine infection rate, puerperal morbidity, and perinatal morbidity in group D were 17.21% , 15.23% , and 21.85%, which were statistically significantly higher than those in group A （0. 94%, 1.41%, 4.09% ）, group B （2. 84%, 2. 73%, 5.47% ）, and group C （5.34%, 5.50%, 7. 60% ） （P 〈 0. 01 ）, there was no statistically significant difference in the incidence of postpartum hemorrhage among the four groups （ P 〉 0. 05） . Conclusion ： Among the pregnant women with full - term and near - term PROM, expectant therapy is mainly used in the women within 12 hours after PROM, while the women without spontaneous labor at 12 - 24 hours after PROM, active programed delivery should be conducted to reduce the cesarean section rate and the incidences of maternal and infantile complications.