胎膜早破产妇的临床特点及干预措施研究

Study of clinical characteristic and intervening measure on premature rupture of fetal membranes in puerpera

目的探讨胎膜早破产妇的临床特点及干预措施。方法选取本院2015年2-10月接诊的80例胎膜早破产妇作为研究组,另外选取80例未发生胎膜早破的产妇作为对照组。对照组根据孕周及产程情况采取常规干预措施,研究组在根据孕周观察产程进展的同时,需监测产妇体温、C反应蛋白、血常规及降钙素原等指标,通过产科彩超及胎心监测、了解胎儿宫内情况,破膜〉12 h给予预防感染等干预措施。比较两组的分娩方式、新生儿早产率、并发症发生率以及产妇感染发生率等。结果研究组产妇的自然分娩率为55.0%,显著低于对照组的77.5%,差异有统计学意义（P〈0.05）。研究组的阴道助产率和剖宫产率分别为17.5%和27.5%,显著高于对照组产妇的7.5%和15.0%,差异有统计学意义（P〈0.05）。研究组的早产率、新生儿窒息发生率、新生儿肺炎发生率分别为15.0%、11.25%、8.75%,显著高于对照组的5.0%、2.50%和1.25%,差异有统计学意义（P〈0.05）。研究组的感染总发生率为21.25%,显著高于对照组的2.50%,差异有统计学意义（P〈0.05）。结论胎膜早破产妇具有较高的阴道助产率和剖宫产率,这加重了产妇的产后感染发生率。临床上应根据产妇的身体特征、相关感染性指标以及临床症状制订相应的诊断措施,以降低产后并发症发生率和感染率。

Guangdong Province; Objective To explore the clinical characteristic and intervening measure on premature rupture of fetal membranes in puerpera. Methods 80 puerperae with premature rupture of fetal membranes from February to October in2015 in our hospital were selected as the research group,another group of 80 puerperae without premature rupture of fetal membranes was selected as the control group.The control group was given regular intervening measure on the basis of gestational weeks and stages of labor.Body temperature,C-reactive protein,blood routine examination,and procalcitonin were monitored in the research group according to gestational weeks observation of birth process at the same time,the fetal condition in utero was understood by color Doppler ultrasound and fetal heart monitoring.Infection prevention was offered if rupture of fetal membrane was over 12 hours.The delivery mode,premature birth rate of neonate,incidence rate of complication,and the incidence rate of infection in puerperae was ccompared in the two groups. Results The natural childbirth rate in the research group was 55.0%,which was lower than 77.5% in the control group,with significant difference（P〈0.05）.The vaginal midwifery rate and rate of cesarean section in the research group were 17.5% and27.5% respectively,which was higher than 7.5% and 15.0% in the control group,with significant difference（P〈0.05）.The premature birth rate,the incidence rate of neonatal asphyxia,and the incidence rate of pneumonia of newborn in the research group was 15.0%,11.25% and 8.75% respectively,which was higher than 5.0%,2.5%,1.25% in the control group,with significant difference（P〈0.05）.The total incidence rate of infection in the research group was 21.25%,which was higher than 2.5% in the control group,with significant difference（P〈0.05）. Conclusion The vaginal midwifery rate and rate of cesarean section are high in puerperae with premature rupture of fetal membranes,which aggravates incidence rate of postpartum infection.The diagnostic measures should be formulated based on puerperal physical characteristics,related infectious index,and clinical manifestations in order to decrease incidence rate of complication and infection rate after delivery.