足月胎膜早破孕妇的分娩方案与母婴结局研究

Study on delivery plan and maternal-fetal outcome of pregnant women with premature rupture of the membranes at term

目的探究足月胎膜早破孕妇的分娩方案与母婴结局。方法选取2014年6月至2016年6月于南京市浦口区中心医院妇产科住院分娩的孕妇1 254例,将其中157例足月胎膜早破孕妇设为观察组,另1 097例无胎膜早破孕妇设为对照组,观察分析两组孕妇分娩方案(剖宫产、阴道自娩、阴道助产)与母婴结局(产后出血、胎盘早剥、绒毛膜羊膜炎、伤口愈合不良、产褥病率、胎儿早产、胎儿窘迫、胎粪吸入性肺炎、1 min及5 min的Apgar评分)情况。结果观察组孕妇的剖宫产率为43.9%,明显低于对照组的57.0%,阴道自产率和阴道助产率分别为52.9%和3.2%,均明显高于对照组的42.8%和0.2%,差异均具有统计学意义(P<0.05);观察组孕妇产后出血、胎盘早剥、绒毛膜羊膜炎、伤口愈合不良的发生率分别为6.4%、9.6%、8.9%、3.8%,均明显高于对照组的3.4%、3.3%、3.5%、2.5%,差异均具有统计学意义(P<0.05);观察组孕妇胎儿早产、胎儿窘迫、胎粪吸入性肺炎发生率分别为8.3%、4.5%、4.5%,均明显高于对照组的3.3%、1.9%、2.1%,差异均具有统计学意义(P<0.05);两组孕妇产褥病率、新生儿1 min及5 min的Apgar评分比较差异均无统计学意义(P>0.05)。结论足月胎膜早破孕妇的产道自产与产道助产的几率明显提高,其不良的母婴结局主要体现在产后出血、产妇并发症以及新生儿的并发症方面。

Objective To explore delivery plan and maternal-fetal outcome of pregnant women with premature rupture of membranes at term. Methods A total of 1 254 pregnant women, who hospitalized in Department of Obstetrics and Gynecology of Pukou District Central Hospital of Nanjing City from June 2014 to June 2016 were selected,among which, 157 pregnant women with premature rupture of membranes at term were treated as the observation group.Besides, 1 097 pregnant women without premature rupture of membranes were treated as the control group. The delivery program（cesarean section, vaginal self-delivery, vaginal midwifery） and maternal and child outcomes（postpartum hemorrhage, placental abruption, chorioamnionitis, poor wound healing, mattress rate, fetal preterm birth, fetal distress, meconium aspiration pneumonia, 1 min and 5 min Apgar scores） of the two groups were observed. Results The rate of cesarean section in the observation group was 43.9%, which was significantly lower than 57.0% in the control group（P〈0.05）. The vaginal yield and vaginal feeding rate were 52.9% and 3.2% respectively, which were significantly higher than 42.8% and 0.2% of the control group. The incidence of postpartum hemorrhage, placental abruption, chorioamniositis and wound healing in the observation group were 6.4%, 9.6%, 8.9% and 3.8%, respectively, which were significantly higher than corresponding 3.4%, 3.3%, 3.5%, 2.5% in the control group（P〈0.05）. The odds of preterm delivery, fetal distress, meconium aspiration pneumonia in the observation group were 8.3%, 4.5% and 4.5%, respectively, which were significantly higher than corresponding 3.3%, 1.9% %, 2.1% in the control group（P〈0.05）. There was no significant difference in Apgar score between neonatal 1 min and 5 min（P〈0.05）. Conclusion Premature rupture of membranes at term in the birth canal production and birth canal significantly increase the chance of midwifery. Poor mother and child outcomes are mainly reflected in postpartum hemorrhage, maternal complications and neonatal complications.