早产胎膜早破剩余羊水量与围产结局的关系

Relationship between residual amniotic fluid volume and perinatal outcomes in preterm premature rupture of membranes

目的探讨早产胎膜早破(PPROM)剩余羊水量与围产结局的关系。方法回顾性分析羊水正常(A组)、羊水偏少(B组)、羊水过少(C组)的PPROM患者各68例临床资料。比较三组分娩方式、围产期并发症、围产儿存活情况及存活新生儿出生后1.5 min阿氏评分(Apgar评分)差异,并利用Pearson相关性分析评估存活新生儿Apgar评分与剩余羊水量的相关性。结果三组阴道助产率、胎盘早剥发生率比较,差异无统计学意义(P>0.05)。三组自然分娩率、剖宫产率及部分围产期并发症(羊膜腔感染、绒毛膜羊膜炎、羊水粪染)发生率、围产儿生存率比较,差异均有统计学意义(P<0.05);两两比较发现,B组与C组自然分娩率及剖宫产率比较,差异无统计学意义(P>0.05);而A组自然分娩率明显高于B组及C组(P<0.05),剖宫产率则低于B组及C组(P<0.05);A组与B组上述围产期并发症发生率、围产儿生存率比较,差异无统计学意义(P>0.05);而C组上述围产期并发症发生率明显高于A组与B组(P<0.05),围产儿生存率则低于A组及B组。以羊水量为自变量(正常=0,偏少=1,过少=2),上述围产期并发症为因变量,行logstie回归分析,发现羊水量与上述围产期并发症无显著相关性(OR=1.029.1.117.1.004.1.045,P>0.05)。三组存活新生儿出生后1.5 min Apgar评分比较.差异均有统计学意义(P<0.05),且变化趋势均为A组>B组>C组(P<0.05)。经Pearson相关性分析发现,存活新生儿出生后1.5 min Apgar评分与其孕母:剩余羊水量呈正相关(r=0.402.0.371,P<0.05)。结论PPROM患者剩余羊水量与新生儿缺氧程度密切相关,且剩余羊水量的减少会增加剖宫产率,羊水过少还会增加不良母婴结局风险,临床应予以重视。

Objective To explore the relationship between residual amniotic fluid volume and perinatal outcomes in preterm premature rupture of membranes(PPROM).Methods The clinical data of each 68 PPROM patients with normal amniotic fluid(group A),less amniotic fluid(group B)and oligohydramnios(group C)were retrospectively analyzed.The delivery modes,perinatal complications,survival of perinatal infants and Apgar score at 1 min and 5 min after birth of live-bom neonates were compared among the three groups.Pearson correlation analysis was used to evaluate the correlation between Apgar score of surviving neonates and residual amniotic fluid.Results There was no significant difference in the incidence of vaginal midwifery and placental abruption among the three groups(P>0.05).There were significant differences in natural delivery rate,cesarean section rate,incidence of some perinatal complications(amniotic cavity infection,chorioamnionitis,amniotic fluid fecal staining)and perinatal survival rate among the three groups(P<0.05);There was no significant difference in natural delivery rate and cesarean section rate between group B and group C(P>0.05);The natural delivery rate in group A was significantly higher than that in group B and C(P<0.05),and the cesarean section rate was lower than that in group B and C(P<0.05);There was no significant difference in the incidence of perinatal complications and perinatal survival between group A and group B(P>0.05);The above perinatal complications in group C were significantly higher than those in group A and group B(P<0.05),and the perinatal survival rate was lower than that in group A and group B.Using amniotic fluid volume as the independent variable(normal=0,less=1,too little=2)and the above perinatal complications as the dependent variable,logistic regression analysis showed that there was no significant correlation between amniotic fluid volume and the above perinatal complications(OR=1.029,1.117,1.004,1.045,P>0.05).There were significant differences in Ap-gar scores at 1 min and 5 min after birth among the three groups(P<0.05),and the change trend was group A>group B>group C(P<0.05).Pearson correlation analysis showed that there was a significant positive correlation between Apgar score at 1 min and 5 min after birth and the residual amniotic fluid of pregnant mothers(r=0.402,0.371,P<0.05).Conclusions Residual amniotic fluid volume in PPROM patients is closely related to the degree of neonatal hypoxia,and the reduction of residual amniotic fluid can also increase the cesarean section rate,and oligohydramnios can also affect maternal-infant outcomes,thus it is necessary to pay attention to clinical practice.