未足月胎膜早破孕周及期待期对妊娠结局的影响

Effets of gestational weeks and latency on pregnancy in preterm premature rupture of membranes

目的分析不同孕周发生的未足月胎膜早破及其期待期对妊娠结局的影响。方法对2010年1月~2015年4月在我院住院分娩的322例（28~36＋6周）PPROM临床病例资料进行分析。按PPROM发生时孕周分成两组：1孕28~33＋6周;2孕34~36＋6周。根据期待期是否达到48 h,两组再各分为两个组,分别对比两组不同期待期与妊娠结局的关系。结果孕28~33＋6周PPROM组发生绒毛膜炎、胎儿窘迫、新生儿呼吸窘迫综合征均高于孕34~36＋6周PPROM组;孕34~36＋6周PPROM孕妇,期待期超过48 h组发生绒毛膜炎、产后出血、新生儿感染的比例明显高于期待期在48 h内组。孕28~33＋6周PPROM孕妇,期待期超过48 h组发生胎儿窘迫、新生儿窒息均低于期待期在48 h内组;并未增加母儿其他不良反应发生。结论对孕28~33＋6周PPROM可采取促胎肺成熟、抑制宫缩和预防感染处理,尽可能延长期待期48 h以上或34周后终止妊娠;对孕34~36＋6周PPROM应尽快终止妊娠。

Objective To explore the effects of different gestational weeks and latency on pregnancy in preterm premature rupture of membranes. Methods All 322 cases of PPROM （28-36＋6 weeks） hospitalized from January 2010 to April 2015 were retrospective studied. All cases were divided into two groups by gestational weeks：（ 1）28-33＋6 gesta- tional weeks; （2）34-36＋6 gestational weeks; each group was further divided into two subgroups by latency, the analysis on the relationship between pregnant weeks,latency and maternal-neonatal outcome was conducted. Results The inci- dences of chorioamnionitis,fetal distress and NRDS in 28-33＋6 weeks group were significantly higher than which in 34- 33＋6 weeks group. In 34-36＋6 weeks of PPROM, the incidences of chorioamnionitis,postpartum hemorrhage and neonatal infection were higher in latency over 48 h group than latency within 48 h group. In 28-33＋6 group, the incidences of fetal distress and neonatal asphyxia were lower in group of latency over 48 h than which in group of latency within 48 h. There was no difference of other maternal-neonatal complication incidence between the different latency. Conclusion The suitable measures to treat PPROM of 28-33＋6 gestational weeks are uterine contraction inhibition, fetal lung matu- ration promotion, infection prevention, extending lantency over 48 h or terminating pregnancy after 34 gestational weeks. To the patients with PPROM at 34-36＋6 gestational weeks,the termination of pregnance promptly is the suitable measure to treat.