小孕龄未足月胎膜早破孕妇不良妊娠结局的影响因素分析

Influencing factors of adverse pregnancy outcomes in pregnant women with small gestational age preterm premature rupture of membranes

目的分析小孕龄未足月胎膜早破(PPROM)孕妇发生不良妊娠结局的影响因素。方法选取2016年1月至2020年12月首都医科大学附属北京妇产医院收治的276例孕20~27;周PPROM孕妇作为研究对象,均接受期待保胎治疗,并随访至妊娠结束。依据孕妇是否发生不良妊娠结局分为发生组(193例)与未发生组(83例),比较2组孕妇基线资料,采用Logistic回归模型分析PPROM孕妇发生不良妊娠结局的影响因素。结果276例PPROM孕妇中发生不良妊娠结局193例,发生率为69.9%。发生组合并妊娠期糖尿病、生殖道感染比例高于未发生组,胎膜早破孕周小于未发生组,期待治疗时间长于未发生组,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,合并妊娠期糖尿病(比值比=4.428,95%置信区间:1.191~16.462,P=0.026)、合并生殖道感染(比值比=2.734,95%置信区间:1.074~6.961,P=0.035)、期待治疗时间长(比值比=1.200,95%置信区间:1.106~1.301,P<0.001)均是小孕龄PPROM孕妇发生不良妊娠结局的独立危险因素,胎膜早破孕周晚(比值比=0.689,95%置信区间:0.602~0.788,P<0.001)是独立保护因素。结论小孕龄PPROM孕妇不良妊娠结局发生率较高,妊娠期糖尿病、生殖道感染、期待治疗时间长是小孕龄PPROM孕妇发生不良妊娠结局的独立危险因素,胎膜早破孕周晚是独立保护因素。

Objective To analyze the influencing factors of adverse pregnancy outcomes in pregnant women with small gestational age preterm premature rupture of membranes(PPROM).Methods From January 2016 to December 2020,276 pregnant women at 20-27;gestational weeks with PPROM admitted to Beijing Obstetrics and Gynecology Hospital,Capital Medical University were selected.All of them received expectant fetal protection treatment and were followed-up to the end of pregnancy.According to whether the pregnant women had adverse pregnancy outcomes,they were divided into the occurrence group(193 cases)and the non-occurrence group(83 cases).Baseline data of pregnant women in the two groups were collected and compared.Logistic regression model was used to analyze the influencing factors of adverse pregnancy outcomes in pregnant women with PPROM.Results Among 276 cases of pregnant women with PPROM,193 cases had adverse pregnancy outcomes,and the incidence was 69.9%.The proportions of combined gestational diabetes mellitus and combined reproductive tract infections in the occurrence group were higher than those in the non-occurrence group,the gestational week of premature rupture of membranes in the occurrence group was smaller than that in the non-occurrence group,the expectant treatment duration in the occurrence group was longer than that in the non-occurrence group,and the differences were statistically significant(all P<0.05).Multivariate Logistic regression analysis showed that combined with gestational diabetes mellitus(odds ratio=4.428,95%confidence interval:1.191-16.462,P=0.026),combined with reproductive tract infections(odds ratio=2.734,95%confidence interval:1.074-6.961,P=0.035)and long expectant treatment duration(odds ratio=1.200,95%confidence interval:1.106-1.301,P<0.001)were independent risk factors for adverse pregnancy outcomes in pregnant women with small gestational age PPROM,and late gestational week of premature rupture of membranes(odds ratio=0.689,95%confidence interval:0.602-0.788,P<0.001)was an independent protective factor.Conclusions The incidence of adverse pregnancy outcomes is high in pregnant women with small gestational age PPROM.Gestational diabetes mellitus,reproductive tract infection and long expectant treatment duration are risk factors for adverse pregnancy outcomes in pregnant women with small gestational age PPROM,and late gestational week of premature rupture of membranes is an independent protective factor.