未足月胎膜早破的相关危险因素及新生儿结局的临床分析

Clinical analysis on related risk factors of premature rupture of membranes and neonatal outcomes

目的分析未足月胎膜早破(PPROM)的相关危险因素,探讨其对新生儿结局的影响,以指导正确预防、处理胎膜早破(PROM),改善新生儿预后。方法选取2011年2月-2015年10月该院602例PROM住院分娩孕妇,调取病历资料,统计孕妇一般人口学特征和医学指征资料,将PPROM纳入早产组,余者纳入足月组,进行组间对比。结果 PPROM 100例,占16.61%,早产组年龄、BMI与足月组差异无统计学意义(P>0.05);早产组生殖道感染率、双胎或多胎妊娠率、人工流产史、主动或被动吸烟、负性事件、产检次数<5次比重高于足月组,早产组其他/原因不明比重低于足月组,差异有统计学意义(P<0.05);多因素非条件Logistic回归分析,产检次数成为保护因素[OR=0.478,95%CI(0.245~0.763)],多胎妊娠[OR=13.762,95%CI(9.265~15.463)]为独立危险因素;早产组低体重儿、窒息率、FGR发生率高于足月组,差异有统计学意义(P<0.05)。结论医院需做好危险因素管理;新生儿科需做好应急管理,做好与产科协调工作,为新生儿救护做好准备。

Objective To analyze the related risk factors of premature rupture of membranes（ PPROM）,explore the impact on neonatal outcomes,guide correct prevention and treatment of PPROM,and improve the prognosis of premature infants. Methods A total of 602 pregnant women with PROM were selected from the hospital from February 2011 to October 2015,the medical records were obtained,the general demographic characteristics and medical indications data was analyzed statistically,all the pregnant women were divided into premature delivery group and mature delivery group,a comparison between groups was performed. Results The proportion of pregnant women with PPROM accounted for 16. 61%（ 100 pregnant women）,there was no statistically significant difference in age and body mass index（ BMI） between the two groups（ P〉0. 05）; the rates of reproductive tract infection,twin pregnancy or multiple pregnancy,abortion history,active or passive smoking,negative events,the times of prenatal examination 〈5 in premature delivery group were statistically significantly higher than those in mature delivery group（ P〈0. 05）,the proportions of other or unknown factors in premature delivery group were statistically significantly lower than those in mature delivery group（ P〈0. 05）; multivariate logistic regression analysis showed that the times of prenatal examination was the protective factor [OR = 0. 478,95% CI（ 0. 245-0. 763） ],multiple pregnancy [OR = 13. 762,95% CI（ 9. 265-15. 463） ] was the independent risk factor; the incidence rates of low birth weight infants,asphyxia,and fetal growth restriction（ FGR） in premature delivery group were statistically significantly higher than those in mature delivery group（ P〈0. 05）. Conclusion The management of risk factors in hospital should be enhanced; emergency management in Department of Neonatalogy and the coordination with Department of Obstetrics should be strengthened to prepare for neonatal care.