胎盘绒毛膜羊膜炎的高危因素与新生儿不良结局的分析

High risk factors of placental chorioamnionitis and the correlation with neonatal adverse outcomes

目的探讨发生胎盘绒毛膜羊膜炎的高危因素及其与新生儿不良结局的相关性。方法回顾分析2015年1月至12月在潍坊市妇幼保健院诊断胎盘绒毛膜羊膜炎的产妇及其新生儿资料,其中病理诊断为绒毛膜羊膜炎的产妇共189例,作为绒毛膜羊膜炎组,病理证实无胎盘、胎膜病变者为对照组,共131例,分析引起绒毛膜羊膜炎的高危因素,并比较其与新生儿不良结局之间的关系。结果 (1)绒毛膜羊膜炎组中剖宫产、胎膜早破>24h、产前发热、产前C-反应蛋白(CRP)升高的发生率均高于正常组,差异均有统计学意义(χ~2值分别为5.665、13.386、18.693、15.933,均P<0.05),虽然单纯胎膜早破>12h无统计学意义,但当胎膜早破<12h并合并母亲产前发热、产前CRP升高时,发生绒毛膜羊膜炎的比例明显升高,差异有统计学意义(χ~2值分别为12.694、6.522,均P<0.05)。(2)绒毛膜羊膜炎组新生儿窒息、新生儿宫内感染、新生儿呼吸窘迫综合征、宫内感染性肺炎、围产期脑损伤及围产期死亡与对照组比较,差异均有统计学意义(χ~2值分别为26.074、31.411、8.928、10.247、8.829、7.155,均P<0.05)。结论胎盘病理诊断对新生儿发病病因诊断及预防、治疗新生儿并发症具有重要参考价值。建议胎膜早破>24h,以及虽然胎膜早破时间短但合并产前发热、产前CRP升高、新生儿窒息、围产儿死亡等均应行胎盘病理检查。对于高危孕妇尤其是合并胎膜早破或产前发热者,需要动态监测血清CRP水平。

Objective To discuss the high risk factors of placental chorioamnionitis and the correlation with neonatal adverse outcomes.Methods A retrospective study was conducted on data of pregnant women diagnosed with placental chorioamnionitis in Weifang Maternity and Child Care Hospital and their neonates during January to December in 2015. There were 189 cases pathologically diagnosed with chorioamnionitis（ chorioamnionitis group） and 131 cases without placental or fetal membrane lesions confirmed by pathology（ control group）. The high risk factors of chorioamnionitis were analyzed and their correlation with neonatal adverse outcomes was compared.Results The incidence of cesarean delivery,premature rupture of membranes（ 24 hours）,prenatal fever and prenatal elevated CRP in chorioamnionitis group was higher than in the control group,and the differences were statistically significant（ χ^2 value was 5. 665,13. 386,18. 693 and 15. 933,respectively,all P〈0. 05）. Although simple premature rupture of membranes 12 h was not statistically significant,the cases with premature rupture of membranes 12 h combined with maternal prenatal fever and prenatal elevated CRP had higher incidence of chorioamnionitis with significance（ χ^2 value was 12. 694 and 6. 522,respectively,both P〈0. 05）. The differnces in neonatal asphyxia,neonatal intrauterine infection,neonatal respiratory distress syndrome,intrauterine infectious pneumonia,perinatal brain injury and perinatal death were statistically significant between two groups（ χ^2 value was 26. 074,31. 411,8. 928,10. 247,8. 829 and 7. 155,respectively,all P〈0. 05）. Conclusion Placental pathologic diagnosis is of importance to the diagnsis and prevention of neonatal disease etiology and treatment of neonatal complications. It is suggested to take placental pathological examination when premature rupture of membranes happened more than 24 hours before and when premature rupture of membranes happened later but complicating prenatal fever,prenatal elevated CRP,neonatal asphyxia and perinatal death. For high risk pregnant women,especially in case of premature rupture of membranes or prenatal fever,serum CRP level should be monitored dynamically.