足月胎膜早破的引产时机对妊娠结局的影响

The Influence of Induction Time for Premature Rupture of Membranes in Term Pregnancy on Pregnancy Outcomes

目的:探讨足月胎膜早破孕妇引产时机对妊娠结局的影响。方法:选取青岛大学附属医院和临沂市中心医院2015年1月—2017年12月足月妊娠胎膜早破孕妇1 474例,根据宫颈评分及引产时间分为4组。A组,Bishop评分≥6分,破膜2 h未临产缩宫素引产;B组,Bishop评分≥6分,破膜12 h未临产缩宫素引产;C组,Bishop评分<6分,破膜2 h未临产缩宫素引产;D组Bishop评分<6分,破膜12 h未临产缩宫素引产。回顾性分析4组的妊娠结局。结果:A、B两组间阴道分娩率差异无统计学意义(P>0.05);而D组阴道分娩率高于C组,差异有统计学意义(P<0.05)。A组的产褥期感染率、引产并发症总发生率明显低于B组(P<0.05),而C组孕妇引产并发症总发生率、胎儿窘迫率、新生儿转科率高于D组(P<0.05)。结论:足月胎膜早破孕妇,宫颈成熟者可破膜后2 h引产,宫颈不成熟者,可期待至破膜后12 h引产。

Objective:To investigate the influence of induction time on pregnancy outcomes in women with premature rupture of membranes (PROM) in full-term pregnancy. Methods: A total of 1 474 pregnant women with PROM were selected from Affiliated Hospital of Qingdao University and Linyi Central Hospital from January 2015 to December 2017. They were divided into four groups according to Bishop score and induction time including group A (Bishop score ≥6 points, and patients were induced by oxytocin without labor after 2 h of rupture), group B (Bishop score ≥6 points, and patients were induced by oxytocin without labor after 12 h of rupture), group C (Bishop score<6 points, and patients were induced by oxytocin without labor after 2 h of rupture), group D (Bishop score<6 points, and patients were induced by oxytocin without labor after 12 h of rupture). We analyzed the pregnancy outcomes in the four groups. Results: The rate of vaginal delivery had no significant difference between group A and group B (P>0.05). The vaginal deliver rate in group D was higher than that in group C (P<0.05). The rates of puerperal infection and complications of induction in group A were lower than those in group B (P<0.05). The rate of complications of induction, fetal distress and neonatal admission in group C were higher than those in group D (P<0.05). Conclusions: The induced labor can be conducted after 2 h of rupture when the cervical is mature in patients with PROM, otherwise it should be delay to after 12 h.