未足月胎膜早破患者易发因素分析及妊娠结局探讨

Discussion on Predisposing Factors of Patients with Preterm Premature Rupture of the Membranes and Pregnancy Outcome

目的探讨未足月胎膜早破(preterm premature rupture of membranes,PPROM)患者的主要易发因素,并观察母婴结局,为临床预防及治疗提供依据。方法选择本院2013年1月至2015年3月间PPROM患者117例为观察组,并选取同期正常产妇112例为对照组,观察比较两组PPROM的相关易发因素及妊娠结局。结果观察组阴道炎宫颈炎史、引产流产史、瘢痕子宫、胎位异常、糖尿病/妊高征和性生活等的比例分别为27.35%(32/117)、23.93%(28/117)、11.11%(13/117)、15.38%(18/117)、12.82%(15/117)和10.26%(12/117),均高于对照组,差异均具有统计学意义(P<0.05);两组双胎妊娠比例差异无统计学意义(P>0.05)。观察组阴道顺产率、阴道助产率和剖宫产率分别为19.66%(23/117)、39.32%(46/117)和41.03%(48/117),与对照组比较,差异具有统计学意义(P<0.05)。观察组新生儿窒息、新生儿肺炎、产后出血、产褥感染、绒毛膜羊膜炎、呼吸窘迫综合征(NRDS)、早产和围生儿死亡的发生率分别为17.95%(21/117)、7.69%(9/117)、12.82%(15/117)、22.22%(26/117)、8.55%(10/117)、15.38%(18/117)、94.87%(111/117)和5.13%(6/117),均高于对照组,差异均具有统计学意义(P<0.05)。观察组新生儿体重和Apgar评分分别为(1 788.20±276.54)g和(7.39±0.60)分,均低于对照组,差异具有统计学意义(P<0.05)。观察组产妇分娩后住院天数为(9.62±0.63)d,显著长于对照组,差异具有统计学意义(P<0.05)。结论未足月胎膜早破(PPROM)患者的易感因素复杂,阴道炎宫颈炎史、引产流产史、瘢痕子宫、胎位异常、糖尿病/妊高征和性生活等均可引发,PPROM新生儿并发症较多,临床上应重视PPROM妊娠前检查和保健,并及时发现其易发因素,以改善妊娠结局。

Objective To discuss the main predisposing factors of preterm premature rupture of membranes （PPROM）, and observe the outcomes of mother and infant, so as to provide evidence for clinical prevention and treatment. Methods 117 cases of PPROM patients hospitalized from January 2013 to March 2015 were selected as observation group, 112 cases of normal puerpera at the same period were selected as control group, to observe and compare the related predisposing factors of PPROM and pregnancy outcomes. Results The percentage of vaginitis/cervicitis history, abortion history, uterine scar, fetal abnormalities, diabetes/pregnancy-induced hypertension and sexual life of the observation group was 27.35% （32/117）, 23.93% （28/117）, 11.11% （13/117）, 15.38% （18/117）, 12.82% （15/117） and 10.26%（12/117） respectively, significantly higher than that of the control group, respectively （P〈0.05）;No statistical difference was found in twin pregnancy. The rates of vaginal spontaneous delivery, vaginal assistant delivery and caesarean section of the observation group were 19.66%（23/117）, 39.32%（46/117） and 41.03%（48/117） respectively, significantly different from those of the control group （P〈0.05）. The incidence of neonatal asphyxia, neonatal pneumonia, postpartum hemorrhage, puerperal infection, chorioamnionitis, neonatal respiratory distress syndrome （NRDS）, premature birth and perinatal mortality of the observation group was 17.95%（21/117）, 7.69%（9/117）, 12.82%（15/117）, 22.22%（26/117）, 8.55%（10/117）, 15.38%（18/117）, 94.87%（111/117） and 5.13%（6/117） respectively, significantly higher than that of the control group, respectively （P〈0.05）. The birth weight and Apgar score of the observation group were （1 788.20 ± 276.54） g and （7.39 ± 0.60） points respectively, significantly lower than those of the control group （P〈0.05）. The length of hospital stay after childbirth of the observation group was （9.62 ± 0.63） d, significantly longer than that of the control group （P〈0.05）. Conclusions PPROM patients have complex predisposing factors, which can be caused by vaginitis/cervicitis history, abortion history, uterine scar, fetal abnormalities, diabetes/ pregnancy-induced hypertension and sexual life. Newborns of PPROM patients have more complications. Clinical doctors should pay attention to PPROM check and health care before pregnancy, and detect its predisposing factors to improve the outcome of pregnancy.