足月胎膜早破孕妇发生绒毛膜羊膜炎的影响因素分析及其对母儿围产结局的影响

Chorioamnionitis in women with term premature rupture of membranes:risk factors and impact on maternal and infant perinatal outcomes

目的探讨足月胎膜早破孕妇发生绒毛膜羊膜炎的影响因素及其对母婴分娩结局的影响。方法回顾2020年1~12月在北京大学首钢医院分娩的足月胎膜早破孕妇192例临床资料,按照是否发生绒毛膜羊膜炎分为观察组37例和对照组155例。通过单因素分析及多因素Logistic回归分析孕妇发生绒毛膜羊膜炎的影响因素,探讨早期亚临床绒毛膜羊膜炎的化验指标;同时比较其对母婴分娩结局的影响。结果孕前超重,孕期增重超标,院前破水,孕期贫血,孕晚期超声羊水指数<8 cm,胎膜早破(PROM)后阴道操作引产以及产时破水>24 h是足月PROM产妇发生CAM的高危因素。2组患者发热前或分娩前24 h内末次白细胞计数(WBC)≥12×10^(9)/L,中性粒细胞比率(NE%)≥75%,C-反应蛋白(CRP)≥6 mg/L差异有统计学意义,其中NE%≥75%及CRP≥6 mg/L敏感度及阴性预测值较高。2组患者剖宫产率,分娩出血量,产后出血率,产褥感染/切口感染率差异有统计学意义(P<0.05),2组围产儿胎儿窘迫发生率,新生儿高胆红素血症发生率及新生儿感染发生率差异有统计学意义(P<0.05)。结论绒毛膜羊膜炎严重影响母婴分娩结局,应加强宣教孕前控制体重,孕期注意体重管理,注意孕期贫血的纠正,普及院前胎膜早破正确处理方法,重视孕晚期超声检查;应尽量减少阴道操作同时注意无菌操作。分娩前血常规及CRP检查对于发现亚临床绒毛膜羊膜炎有重要意义。建议足月胎膜早破患者尤其是合并高危因素者,定期动态监测血常规及血清CRP水平。

Objective To investigate the influencing factors of chorioamnionitis in pregnant women with full-term premature rupture of membranes(PROM)and its impact on maternal and infant perinatal outcomes.Methods The clinical data of 192 full-term pregnant women with PROM who delivered babies at Shougang Hospital of Peking University from January to December 2020 were reviewed.Results Body mass index≥24,excessive weight gain,pre-hospital PROM,anemia,amniotic fluid index<8 cm,and PROM for more than 24 hours were identified to be high risk factors for chorioamnionitis in women with full-term PROM.Last white blood cell count before fever or delivery≥12×10^(9)/L,neutrophil percentage(NE%)≥75%,and C-reactive protein(CRP)≥6 mg/L differed significantly between PROM women with and without chorioamnionitis.NE%≥75%and CRP≥6 mg/L had higher sensitivity and negative predictive value in the diagnosis of chorioamnionitis.There were significant differences in cesarean section rate,delivery bleeding,puerperal infection/incision infection rate between women with and without chorioamnionitis.There were also significant differences in the incidence of perinatal fetal distress,neonatal hyperbilirubinemia,and neonatal infection between the two groups.Conclusion Chorioamnionitis seriously affects the maternal and infant outcomes.Women with PROM should be educated to manage weight before and during pregnancy and correct anemia during pregnancy.Proper treatment of pre-hospital PROM and ultrasound examination in the third trimester of pregnancy should be emphasized.Vaginal operation should be avoided and sterile operation should be implemented.Routine blood test and CRP examination are of great significance for the detection of subclinical chorioamnionitis.It is suggested that patients with PROM,especially those with high risk factors for chorioamnionitis,should regularly and dynamically monitor routine blood parameters and serum CRP levels.