有无明显诱因致早产合并胎膜早破的临床对比分析

The Comparative Analysis of Preterm Premature Rupture of Membranes with or without Obviously Predisposing Factors

目的:探讨有、无明显诱因导致早产合并胎膜早破(PPROM)对母儿的影响。方法:收集2004年11月至2012年1月早产合并PPROM 494例患者的临床资料进行回顾性分析,将287例有明显诱发因素的患者作为PPROM(A)组,原因不明早产合并PPROM 207例为PPROM(B)组,比较两组患者一般情况、分娩方式及妊娠结局。结果:①PPROM(A)组孕妇平均年龄及既往不良孕产史发生率均高于PPROM(B)组(29.72±4.81岁vs28.50±4.49岁,P<0.05;4.9%vs0,P<0.05);分娩孕周显著低于PPROM(B)组(33.01±2.40周vs34.01±2.29周,P<0.01)。②PPROM(A)组阴道顺产率明显低于PPROM(B)组(33.1%vs73.4%,P<0.01);剖宫产率则显著升高(63.8%vs25.6%,P<0.01)。③PPROM(A)组孕妇总的并发症发生率高于PPROM(B)组(31.7%vs21.3%,P<0.01),其中,PPROM(A)组羊膜腔感染发生率较PPROM(B)组显著升高(9.1%vs0,P<0.01)。④PPROM(A)组新生儿体重、1分钟Apgar评分均显著低于PPROM(B)组(P<0.01);新生儿窒息率则高于PPROM(B)组(P<0.05)。两组其他方面比较差异无统计学意义(P>0.05)。结论:有明显诱因致早产合并PPROM者,母儿患病率相对较高。孕妇年龄、既往不良孕产史及母亲健康状况可能也与妊娠结局有关。针对不同病因,应采取不同处理措施,以减少母儿并发症。

Objective： To investigate predisposing factors of preterm premature rupture of membranes （PPROM） and its effects on the maternal and perinatal outcomes. Methods.The clinical data of 494 cases of PPROM from November 2004 to January 2012 were retrospectively analyzed. 494 cases were divided into two groups. 287 patients with obviously predisposing factors were in the observation group [ group PPROM （A） l ,while the others were as in control group E group PPROM（B） 1. General conditions, mode of delivery and pregnancy outcomes were compared between the two groups. Results：①ln group PPROM（A）, mean maternal age and mean undesirable previous obstetric history were higher than that of group PPROM（B） （29.72 ±4. 81 vs 28.50 ±4. 49,P〈0.05;4. 9%vs 0,P〈0.05）. While the mean gestational age at delivery was significant lower than that in group PPROM（B） （33. 01 ±2.40 vs 34.01 ±2.29,P〈0.01 ）. ②Compared to group PPROM （ B）, the rate of vaginal deliveryof group PPROM （A） was significantly lower （33. 1% vs 73. 4%, P 〈0.01 ） and cesarean section rate was significantly higher（63.8% vs 25.6%, P 〈 0.01 ）. ③The constituent ratio of maternal complications in group PPROM（A） was higher than that in group PPROM（B） （31.7% vs 21.3%, P 〈 0.01 ）, the intraamniotic infection in group PPROM （A） was higher than that in group PPROM（B） （9. 1% vs 0,P〈0.01 ）. ④Preterm infants in group PPROM（A） had a lower birth weight and lower 1 min Apgar scores than those in group PPROM （B） （ P 〈 0.01 ）. And neonatal morbidity in groupPPROM （A） were higher than the group PPROM （B） （ P 〈 0.05）. There was no statistical difference in other aspects between these two groups （P 〉 0.05 ）. Conclusions： PPROM with obviously predisposing factors has a higher perinatal morbidity. Maternal age, undesirable previous obstetric history and maternal health may have an effect on pregnancy outcomes. So actively find and deal with predisposing factors of PPROM, and strengthening the prenatal examination and perinatal care, are not only important to decrease the rate of cesarean section and perinatal morbidity,but also and to improve the pregnancy outcomes.