足月胎膜早破残余羊水量对妊娠结局的影响

Correlation analysis of outcome of pregnancy according to the residual amount of amniotic fluid after full-term premature rupture of fetal membranes

目的了解足月胎膜早破后残余羊水量对妊娠结局的影响。方法收集143例足月胎膜早破孕产妇临床资料,根据产前B超检测的残余羊水指数(AFI)分为3组:A组(8 cm≤AFI<25 cm)75例,B组(5 cm≤AFI<8 cm)38例,C组(AFI<5 cm)30例,比较3组孕妇在分娩方式、宫内感染率、胎儿窘迫率、新生儿发病率和羊水粪染率等方面的差异。结果 C组剖宫产率高于A组(70.00%vs 37.30%,P<0.05);A组自然分娩率高于B组和C组,差异均有统计学意义(P<0.05)。C组宫内感染发生率、新生儿疾病发生率、羊水粪染率、胎儿窘迫发生率均高于A组,差异有统计学意义(P<0.05),其他组间比较均无统计学差异。Logistic回归分析表明,残余羊水量(OR=2.912)、破膜至分娩时间(OR=2.356)与羊水粪染(OR=1.833)是产妇宫内感染、新生儿疾病发病的影响因素。结论足月胎膜早破后残余羊水量的多少与妊娠结局密切相关,羊水残余量越少对母婴的威胁越大。

Objective To analyze and discuss the impacts of the outcome of pregnancy according to the residual amount of am-niotic fluid after full-term premature rupture of fetalmembranes.Methods 143 puerperas were divided into three groups according to their prenatal B ultrasound detection of residual amniotic fluid index（AFI） results, including Group A （8 cm≤AFI〈25 cm） 75 ca-ses,Group B（5 cm≤AFI〈8 cm） 38 cases and Group C（AFI 〈5 cm） 30 cases.Thedifferenceswere comparedbetween the three groups of pregnant women in mode of delivery, intrauterine infection, fetal distress, neonatal morbidity and meconium stained amniotic fluid rate.Results The cesarean section rate in Group C was significantly higher than in Group A （70.00%vs 37.30%,P〈0.05）. The spontaneous vaginal delivery rates in Group C and Group B were lower than in Group A, with a significant difference（P〈0.05）. The intrauterine infection rate, the incidence of neonatal disease, the meconium stained amniotic fluid rate and the incidence of fetal distress in Group C were higher than in Group A, with statistically significant difference（P〈0.05）.The othercomparisonsbetween groups showed no significant difference.From the Logistic regression analysis results of the risk factors on maternal intrauterine infec-tion rate and neonatal morbidity, it was known that the residual amount of amniotic fluid, the time of membranes ruptured till delivery and the meconium stained amniotic fluid were the main factors influencing the maternal intrauterine infection rate and neonatal morbidi-ty.Conclusions The residual amount of amniotic fluid after full-term premature rupture of fetal membranes closely relates to the preg-nancy outcome.The less the residual amount of amniotic fluid, the more seriousthe threat of maternal and infant health.