绒毛膜羊膜炎与早产儿并发症的关系探讨

Study on the relationship between histological chorioamniontis and neonatal complications after preterm birth

目的探讨绒毛膜羊膜炎与早产儿并发症的关系。方法选择2007—2011年本院住院且分娩后行胎盘病理检查的早产儿,按是否存在绒毛膜羊膜炎分为绒毛膜羊膜炎组和非绒毛膜羊膜炎组,绒毛膜羊膜炎患儿按是否合并脐带炎分为脐带炎组和非脐带炎组,比较胎盘病理与母婴并发症的关系。结果共纳入115例早产儿,检出绒毛膜羊膜炎54例(47.0%),其中合并脐带炎14例(12.2%)。绒毛膜羊膜炎组和非绒毛膜羊膜炎组比较,前置胎盘(14.8%比31.1%)、胎盘早剥(5.6%比29.5%)、妊娠合并肝内胆汁淤积(0比11.5%)、呼吸窘迫综合征(5.6%比18.0%)和坏死性小肠结肠炎(1.9%比11.5%)的发生率降低;胎膜早破(46.3%比6.6%)和产前使用抗生素的比例(55.6%比8.2%)升高,P均<0.05。与非脐带炎组比,合并脐带炎组胎儿宫内窘迫、出生时新生儿血CRP、晚发型败血症发生率明显升高;母亲妊娠合并高血压比例降低,产前使用抗生素比例增高,P均<0.05。结论胎膜早破是绒毛膜羊膜炎和(或)脐带炎的高危因素,绒毛膜羊膜炎合并脐带炎时表现胎儿宫内窘迫和出生时CRP升高;绒毛膜羊膜炎不增加呼吸窘迫综合征和坏死性小肠结肠炎的发生率。

Objective To study the relationship between histological chorioamniontis and complications of premature birth. Methods Clinical and laboratory data of 115 premature infants were retrospectively analyzed. The patients were admitted to the neonatal ward of Medical Centre for Maternal and Children Health, Suzhou Municipal Hospital from 2007 to 2011. All had antepartum placental anatomopathology done and were assigned into two groups： group Ⅰ （infants with histological chorioamniontis） and group Ⅱ （infants without histological chorioamniontis ）.Group Ⅰwere further allocated into infants with funisitis and infants without funisitis.The relationship between placental anatomopathology and mother/infant complications were investigated. Results Of 115 premature infants, 54 infants （47.0%） had chorioamnionitis and 14 infants （12.2%） had chorioamnionitis with funisitis. We found that the incidence of antenatal complications such as placental previa （14.8% vs. 31.1%）, placental abruption（5.6% vs. 29.5%）,intrahepatic cholestasis of pregnancy （0 vs. 11.5%） and the incidence of neonatal respiratory distress syndrome （RDS,5.6% vs. 18.0%） and necrotizing entercolitis （NEC,1.9 % vs. 11.5%） were decreased significantly in the chorioamnionitis group, while the incidence of preterm premature rupture of membrane （PPROM） （46.3% vs. 6.6%）and antibiotic administration before delivery （55.6% vs. 8.2%） were higher in the chorioamnionitis group,P all 0.05.We also found a significantly higher rates of higher CRP level at birth,antibiotic administration,fetal distress and later-onset sepsis in the chorioamnionitis with funisitis group,P all 0.05. Conclusions PPROM was the risk factor of chorioamnionitis with or without funisitis. This study demonstrated funisitis was associated with higher CRP level and fetal distress.The presence of chorioamniontis was not associated with increased risk of RDS and NEC.