不同孕周胎膜早破后剩余羊水量对分娩方式及妊娠结局的影响

Influence of residual amniotic fluid amount after premature rupture of membrane on the delivery mode and pregnancy outcome at different gestational weeks

目的分析不同孕周胎膜早破后剩余羊水量对分娩方式及妊娠结局的影响。方法选取2013年1月至2018年6月苏州市吴江区中医医院(苏州市吴江区第二人民医院)诊治的198例34周~42周胎膜早破的产妇作为研究对象。按照羊水指数分为剩余羊水过少组(62例),剩余羊水偏少组(68例),剩余羊水正常组(68例),分别比较34周~36周+6天及37周~42周的胎膜早破产妇三组间分娩方式及妊娠结局的差异。结果剩余羊水过少组、剩余羊水偏少组、剩余羊水正常组孕妇年龄比较无统计学意义(P>0.05),34周~36周+6天的孕妇中,剩余羊水过少组破膜至分娩时间、剖宫产率、阴道助产率、1min Apgar评分≤7分、新生儿呼吸窘迫综合征、发热及绒毛膜羊膜炎发生率均明显大于羊水偏少和羊水正常组,差异具有统计学意义(P<0.05),其中剩余羊水偏少组破膜至分娩时间大于羊水正常组,差异具有统计学意义(P<0.05),三组间出生体重、胎儿窘迫及产后出血发生率差异无统计学意义(P>0.05);37周~42周的孕妇中,剩余羊水过少组破膜至分娩时间及剖宫产率明显大于羊水偏少和羊水正常组,差异具有统计学意义(P<0.05),后两组组间比较无统计学差异(P>0.05),三组间阴道助产率、出生体重、胎儿窘迫、1min Apgar评分≤7分、新生儿呼吸窘迫综合征、产后出血、发热及绒毛膜羊膜炎发生率均无统计学差异(P>0.05)。结论孕4周~36周+6天胎膜早破产妇对剩余羊水量的反应较足月胎膜早破敏感,剩余羊水AFI≤5cm可能会影响孕34周~36周+6天胎膜早破产妇的分娩方式,增加不良妊娠结局发生率。

Objective To analyze the influence of residual amniotic fluid amount after premature rupture of membrane(PROM)on the delivery mode and pregnancy outcome at different gestational weeks.Methods The126 parturient women with PROM at 34 gestationalweeks to 42 gestationalweeks in our hospital from January 2013 to June 2018 were selected as the research objects. According to the amniotic fluid index, the parturient women were divided into the oligohydramnios group(60 cases), the borderline oligohydramnios group(68 cases) and normal group(51 cases). The differences in delivery mode and pregnancy outcome among the three groups were compared for women with premature rupture of membranes at 34~36 weeks+6 d and 37~42 weeks respectively. Results There was no statistical significance on the age of pregnant women among the oligohydramnios group, borderline oligohydramnios and normal group(P>0.05). Among pregnant women of 34-36 weeks+6 d, the time of delivery, the cesarean section rate, vaginal midwifery rate, incidence of 1 min Apgar≤7, incidence of neonatal respiratory distress syndrome, incidence of fever and chorioamnionitis in the oligohydramnios group were significantly larger than those of the borderline oligohydramnios and normal group, with statistically significant differences(P<0.05), in which the delivery time in the borderline oligohydramniosgroup was longer than that of the normal group, with statistically significant difference(P <0.05). There were no significant difference in the birth weight, incidence of fetal distress and postpartum hemorrhage among the three groups(P>0.05). Among pregnant women of 37-42 weeks, the delivery imetand cesarean section rate in the oligohydramnios group were significantly greater than that of the borderline oligohydraoupmniosgand normal group, with statistically significant differences(P<0.05), while there were no statistically significant differences between the borderline oligohydramniosgroup and normal groupgroups(P>0.05). There were no statistically significant differences among the three groups in the incidence of vaginal midwives, birth weight, fetal distress, 1 min Apgar≤7, neonatal respiratory distress syndrome, postpartum hemorrhage, fever and chorionic amnionitis(P>0.05). Conclusions The pregnant women with 34~36 weeks+6 d of PROM are more sensitive to the residual amnioticfluid amount than those with full-term PROM. AFI≤5 cm of the residual amniotic fluid may affect the delivery mode of the pregnant women with 34~36 week+6 d of PROM, and increase the incidence of adverse pregnancy outcomes.