足月前胎膜早破剩余羊水量对妊娠结局的影响

Effect of residue amniotic fuid volume on pregnancy outcomes in preterm premature rupture of membranes

目的探讨足月前胎膜早破(PPROM)发生后剩余羊水量与母儿结局的关系。方法选取2008年1月至2013年12月嘉定中心医院产科住院分娩的180例PPROM孕妇,根据胎膜破裂后羊水指数(AFI)结果将孕妇分为羊水量正常组(8 cm<AFI<18 cm)80例,羊水量偏少组(5 cm<AFI<8 cm)60例和羊水量过少组(AFI<5 cm)40例。观察各组孕妇的AFI、孕妇发热情况、白细胞计数、发生PPROM的孕周、潜伏期时限及分娩方式,并对各组孕妇的围产期发病情况进行分析。结果 (1)三组孕妇的破膜时间、白细胞计数、发热等指标比较差异无统计学意义(P>0.05);(2)羊水量过少组孕妇在潜伏期时间、宫内感染、胎儿窘迫、新生儿窒息、剖宫产率方面与羊水偏少组及羊水量正常组比较,差异均有统计学意义(P<0.05);(3)在"社会因素"手术指征方面,羊水过少组与羊水偏少组比较差异无统计学意义(P>0.05),但与羊水正常组比较差异有统计学意义(P<0.05)。结论 PPROM后的剩余羊水量过少与潜伏期缩短、宫内感染、胎儿宫内窘迫、新生儿窒息增加有关。

Objective To analyze the relationship between the residue amniotic fluid volume and the preg-nancy outcomes after the preterm premature rupture of membranes （PPROM）. Methods One hundred and eighty pregnant women with PPROM in Shanghai Jiading Central Hospital from 2008 to 2013 were selected as the research subjects. According to the amniotic fluid index （AFI） after the preterm premature rupture of membranes, patients were divided into three groups：（1） Group of normal amniotic fluid：8 cm〈AFI〈18 cm, 80 cases;（2） Group of borderline oli-gohydramnios：5 cm〈AFI〈8 cm, 60 cases;（3） Group of oligohydramnios：AFI〈5 cm, 40 cases. Each group was stud-ied with AFI, maternal fever cases, white blood cell （WBC） count, gestational age at rupture of membrane, the incuba-tion period and the mode of delivery. Results （1） There were no significant differences among all the groups in the rupture time, WBC count and occurrence of fevers （P〉0.05）. （2） Intrauterine infection, neonatal respiratory distress, neonatal asphyxia and cesarean section rate in of oligohydramnios showed statistically significant differences with those in other two groups （P〈0.05）. （3） Surgical indications of the“social factors”in group of oligohydramnios and group of borderline oligohydramnios showed no statistically significant difference （P〉0.05）, while these indications in the two groups were significantly difference form those in group of normal amniotic fluid （P〈0.05）. Conclusion Oli-gohydramnios after PPROM has closed relationships with the shorter latent period, intrauterine infection, the increas-ing risks of neonatal respiratory distress, and neonatal asphyxia. The amniotic fluid volume may be a quite critical prognostic indicator to assess the outcomes of maternal and neonatal after PPROM occurred.