残余羊水量对早期未足月胎膜早破围产结局影响

The influence of residual oligohydramnios on perinatal outcome of early preterm premature rupture of membranes

目的探讨早期未足月胎膜早破残余羊水量者并发症、分娩方式及早产儿结局。方法 225例26~33+6周单胎胎膜早破者分为残余羊水过少A组67例(其中A1组26~31+6周32例,A2组32~33+6周35例)和羊水量正常B组158例(其中B1组26~31+6周78例,B2组32~33+6周80例),对4组并发症、分娩方式及早产儿结局进行比较。结果白细胞计数A1组高于B1、B2组。C反应蛋白A1组高于A2、B1、B2组。潜伏期A1组低于B1、B2组,高于A2组;A2组低于B1、B2组;B1组高于B2组。剖宫产率A1组高于A2、B1、B2组。绒毛膜羊膜炎A1组高于B1、B2,A2高于B2。胎儿窘迫A1组高于A2、B1、B2组。羊水污染B1、B2组低于A1、A2组。产褥感染A1组高于B1、B2组。差异均有统计学意义(P<0.05)。活婴比例A1组低于B1、B2组;Apgar评分1 min≤7分A1组高于B1、B2组,A2组高于B2组;Apgar评分5 min≤7分、辅助呼吸及宫内感染情况,A1组高于B1、B2组;脐带炎A1、A2组高于B2组;脐动脉p H值A1、A2组低于B1、B2组。其差异具有统计学意义(P<0.05)。AFI≤20 mm中A1、A2组新生儿死亡发生率及剖宫产率差异有统计学意义(P<0.05)。结论对早期未足月胎膜早破残余羊水过少者应严密监测,孕周越小,残余羊水过少对母婴危害越大;相同孕周,残余羊水过少会增加剖宫产率、母亲感染率、早产儿窒息率、死亡发生率,潜伏期缩短;孕26~31+6周合并残余羊水指数≤20 mm,早产儿死亡发生率极高,应慎重选择剖宫产。

Objective To explore the complication,delivery model of pregnancy and the outcomes of premature infant on early preterm premature rupture with residue oligohydramnios. Methods Two hundred and twenty-five cases of 26- 33＋ 6weeks of singletons pregnant women were divided into four groups. Sixty-seven cases of residue oligohydramnios were group A,including group A1 which is 32 cases of 26- 31＋ 6weeks of singletons pregnant women and group A2 which is 35 cases of 32- 33＋ 6weeks of singletons pregnant women. One hundred and fifty-eight cases of normal amniotic fluid were group B,including group B1 which is 78 cases of 26- 31＋ 6weeks of singletons pregnant women and Group B2 which is 80 cases of 32- 33＋ 6weeks of singletons pregnant women. The indexes such as the complication,delivery model of pregnant and the outcomes of premature infant were compared in the four groups. Results In group A1,WBC count is above than that in group B1 and B2; C-reactive protein is higher than that in group A2,B1,B2. Latency period is lower in group A1 than that in group B1 and B2,but is higher than that in group A2,also it is lower in group A2 than group B1 and B2,it is higherin group B1 than that in group B2. The cesarean section rate of group A1 is higher than group A2,B1,B2. Chorioamnionitis is higher in group A1 than in group B1 and B2,it is also higher in group A2 than that in group B2. Fetal distress is above in group A1 than in group A2,B1,B2. Amniotic fluid contamination is lower in group B1 and B2 than that in group A1 and A2. Puerperal infection is higher in group A1 than that in group B1 and B2. There are significant difference in these groups（ P〈0. 05）. The premature infants asphyxia rate is lower and the death rate is higher in group A1 than that in group B1 and B2. Apgar score 1 min≤7 is higher in group A1 than that in group B1 and B2,also it is higher in group A2 than group B2. Apgar score 5 min ≤7,assisted respiration and intrauterine infection are all higher in group A1 than that in group B1 and B2. Umbilical cord inflammation in group A1 and A2 is above than that in group B2. The p H of umbilical arterial is lower in group A1 and A2 than that in group B1 and B2. There are significant difference in all these groups（ P〈0. 05）. In group A1 and A2 with AFI≤20 mm,neonatal mortality and cesarean section rate are significantly different in the two groups（P〈0. 05）. Conclusion Patients of residue oligohydramnios with early preterm premature rupture of membranes should be monitored closely,the smaller of the gestational age,the greater damage of the mother and children. In the same gestational age,residual oligohydramnios were associations with the higher rate of the cesarean section,maternal infection,premature infants asphyxia and mortality; also were associations with the shorter of latency period. The mortality of premature infants of 26- 31＋ 6weeks with AFI≤20 mm is more higher,the cesarean delivery should be choosed carefully.