28~34周胎膜早破后不同残余羊水量产妇的情况和妊娠结局分析

Analysis of situation and pregnancy outcome of parturients with different residual amniotic fluid volume after 28-34 weeks premature rupture of membranes

目的分析28~34周胎膜早破后不同残余羊水量产妇的情况和妊娠结局。方法选取2018年4月至2020年4月本院收治的84例28~34周胎膜早破产妇作为研究对象,依据羊水指数将其分为残余羊水量正常组(羊水指数≥8 cm)、残余羊水量偏少组(羊水指数5~<8 cm)及残余羊水量过少组(羊水指数<5 cm),每组28例。给予产妇常规对症治疗。比较三组的临床相关指标、妊娠结局、新生儿不良事件发生情况及新生儿出生后1 min Apgar评分。结果三组的破膜时间、新生儿体重比较,差异无统计学意义(P>0.05);残余羊水量正常组的潜伏期时间明显长于残余羊水量偏少组、残余羊水量过少组(P<0.05);残余羊水量偏少组的潜伏期时间明显长于残余羊水量过少组(P<0.05)。三组的发热、胎盘早剥、白细胞计数过高及产后出血发生率比较,差异无统计学意义(P>0.05);残余羊水量正常组的剖宫产率明显低于残余羊水量偏少组、残余羊水量过少组(P<0.05);残余羊水量偏少组的剖宫产率明显低于残余羊水量过少组(P<0.05);残余羊水量过少组的羊膜腔感染率明显高于残余羊水量偏少组、残余羊水量正常组(P<0.05)。三组的新生儿呼吸窘迫综合征、呼吸衰竭、黄疸、脑室出血、低血糖、胎儿窘迫、窒息、缺氧性脑病发生率比较,差异无统计学意义(P>0.05);残余羊水量偏少组、残余羊水量过少组的新生儿心肌损害率明显高于残余羊水量正常组(P<0.05)。残余羊水量正常组的出生后1 min Apgar评分明显高于残余羊水偏少组、残余羊水量过少组(P<0.05);残余羊水偏少组的出生后1 min Apgar评分明显高于残余羊水量过少组(P<0.05)。结论28~34周胎膜早破产妇妊娠结局与残余羊水量具有密切关系,胎膜早破产妇羊水过少容易诱发羊膜腔感染、新生儿心肌损害等问题,增加剖宫产发生率。

Objective To analyze the situation and pregnancy outcome of parturients with different residual amniotic fluid volume after 28-34 weeks premature rupture of membranes.Methods A total of 84 parturients with premature rupture of membranes at 28-34 weeks admitted in our hospital from April 2018 to April 2020 were selected as the research objects.According to the amniotic fluid index,the parturients were divided into normal residual amniotic fluid volume group(amniotic fluid index≥8 cm),less residual amniotic fluid volume group(amniotic fluid index 5-<8 cm)and residual oligohydramnios group(amniotic fluid index<5 cm),with 28 cases in each group.The parturients were given routine symptomatic treatment.The clinical related indexes,pregnancy outcome,occurrence of neonatal adverse events and1 min Apgar score after birth were compared among the three groups.Results There were no significant differences in membrane rupture time and neonatal weight among the three groups(P>0.05);the latency time in the normal residual amniotic fluid volume group was significantly longer than that in the less residual amniotic fluid volume group and the residual oligohydramnios group(P<0.05);the latency time in the less residual amniotic fluid volume group was significantly longer than that in the residual oligohydramnios group(P<0.05).There were no significant differences in the incidences of fever,placental abruption,excessive white blood cell count and postpartum hemorrhage among the three groups(P>0.05);the cesarean section rate in the normal residual amniotic fluid volume group was significantly lower than that in the less residual amniotic fluid volume group and the residual oligohydramnios group(P<0.05);the cesarean section rate in the less residual amniotic fluid volume group was significantly lower than that in the residual oligohydramnios group(P<0.05);the infection rate of amniotic cavity in the residual oligohydramnios group was significantly higher than that in the less residual amniotic fluid volume group and the normal residual amniotic fluid volume group(P<0.05).There were no significant differences in the incidences of neonatal respiratory distress syndrome,respiratory failure,jaundice,ventricular hemorrhage,hypoglycemia,fetal distress,asphyxia and hypoxic encephalopathy among the three groups(P>0.05);the myocardial damage rate of neonates in the less residual amniotic fluid volume group and the residual oligohydramnios group was significantly higher than that in the normal residual amniotic fluid volume group(P<0.05).The 1 min Apgar score after birth in the normal residual amniotic fluid volume group was significantly higher than that in the less residual amniotic fluid volume group and the residual oligohydramnios group(P<0.05);the 1 min Apgar score after birth in the less residual amniotic fluid volume group was significantly higher than that in the residual oligohydramnios group(P<0.05).Conclusion The pregnancy outcome of parturients with premature rupture of membranes at 28-34 weeks is closely related to the residual amniotic fluid volume.Oligohydramnios in parturients with premature rupture of membranes can easily induce problems such as amniotic cavity infection and neonatal myocardial damage,and increase the incidence of cesarean section.