产时发热的影响因素

Risk factors of intrapartum fever

目的分析产时发热的影响因素。方法回顾性研究2017年5月1日至2020年5月30日于北京大学国际医院产前检查并分娩、产时发热的357例(发热组)及未发热的454例(未发热组)产妇。收集产妇产前和产时临床资料,采用独立样本t检验、Mann-Whitney U检验或χ^(2)检验进行组间比较,采用单因素和多因素logistic回归分析,筛选与产时发热相关的危险因素。结果(1)发热组年龄≥35岁和合并贫血的比例低于无发热组[10.9%(39/357)与17.0%(77/454),χ^(2)=5.94,P=0.015;7.3%(26/357)与20.3%(92/454),χ^(2)=27.09,P<0.001],总产程及胎膜破裂至胎儿娩出时间长于无发热组[12.7 h(10.0~16.1 h)与8.0 h(5.4~11.2 h),Z=-6.41;11.0 h(6.2~17.7 h)与3.1 h(1.1~8.2 h),Z=-6.41;P值均<0.001],胎膜早破、实施分娩镇痛、分娩时羊水胎粪污染、合并阴道炎和促宫颈成熟的比例高于无发热组[44.3%(158/357)与22.7%(103/434),χ^(2)=42.60;95.2%(340/357)与53.1%(241/454),χ^(2)=174.79;31.6%(113/357)与15.0%(68/454),χ^(2)=32.05;17.1%(61/357)与7.3%(33/454),χ^(2)=18.93;20.4%(73/357)与6.6%(30/454),χ^(2)=34.53;P值均<0.001]。(2)多因素logistic回归分析显示,胎膜早破(OR=2.052,95%CI:1.172~3.606)、分娩镇痛(OR=5.909,95%CI:3.238~11.42)、总产程(OR=1.231,95%CI:1.169~1.299)、分娩时羊水胎粪污染(OR=1.963,95%CI:1.267~3.066)、合并阴道炎(OR=3.587,95%CI:1.943~6.847)、促宫颈成熟(OR=3.947,95%CI:2.243~7.170)和胎膜破裂至胎儿娩出时间(OR=1.045,95%CI:1.012~1.081)是产时发热的独立危险因素(P值均<0.05)。合并贫血(OR=0.358,95%CI:0.192~0.647,P<0.05)可能是产时发热的保护因素。(3)胎膜早破(OR=2.138,95%CI:1.189~3.865)、总产程延长(OR=1.240,95%CI:1.174~1.315)、合并阴道炎(OR=3.353,95%CI:1.719~6.926)、胎膜破裂至胎儿娩出时间延长(OR=1.047,95%CI:1.013~1.085)、分娩时羊水胎粪污染(OR=2.154,95%CI:1.357~3.466)和促宫颈成熟(OR=3.880,95%CI:2.136~7.363)是接受分娩镇痛的产妇发生产时发热的危险因素(P值均<0.05)。结论产时发热的影响因素包括胎膜早破、分娩镇痛、总产程、分娩时羊水胎粪污染、合并阴道炎、促宫颈成熟、胎膜破裂至胎儿娩出时间和合并贫血等。临床医师应加强产妇体温的监测和对产程的管理,关注产时发热的影响因素,尤其应加强对促宫颈成熟、分娩镇痛、胎膜破裂后的产程管理,减少产时发热,改善母婴结局。

Objective To analyze the influencing factors of intrapartum fever.Methods A retrospective analysis was conducted on 357 women with intrapartum fever(fever group)and 454 without(non-fever group)who underwent prenatal examination and delivered at Peking University International Hospital from May 1,2017,to May 30,2020.Clinical data before and during delivery were collected,and univariate and multivariate logistic regression analysis was performed to screen intrapartum fever-related risk factors.Independent sample t-test,Mann Whitney U-test,and Chi-square-test were used to compare groups.Results(1)The proportions of women with age≥35 years and anemia were lower in the fever group than those in the non-fever group[10.9%(39/357)vs.17.0%(77/454),χ^(2)=5.94,P=0.015;7.3%(26/357)vs.20.3%(92/454),χ^(2)=27.09,P<0.001].The total labor duration and the time from membrane rupture to delivery were longer[12.7 h(10.0-16.1 h)vs.8.0 h(5.4-11.2 h),Z=-6.41;11.0 h(6.2-17.7 h)vs.3.1 h(1.1-8.2 h),Z=-6.41;both P<0.001]and the proportions of premature rupture of membranes,labor analgesia,meconium-stained amniotic fluid,vaginitis,and promoting cervical ripening were higher in the fever group than those in the non-fever group[44.3%(158/357)vs.22.7%(103/434),χ^(2)=42.60;95.2%(340/357)vs.53.1%(241/454),χ^(2)=174.79;31.6%(113/357)vs.15.0%(68/454),χ^(2)=32.05;17.1%(61/357)vs.7.3%(33/454),χ^(2)=18.93;20.4%(73/357)vs.6.6%(30/454),χ^(2)=34.53;all P<0.001].(2)Multivariate logistic analysis showed that premature rupture of membranes(OR=2.052,95%CI:1.172-3.606),labor analgesia(OR=5.909,95%CI:3.238-11.42),total labor duration(OR=1.231,95%CI:1.169-1.299),meconium-stained amniotic fluid(OR=1.963,95%CI:1.267-3.066),and vaginitis(OR=3.587,95%CI:1.943-6.847),cervical ripening promotion(OR=3.947,95%CI:2.243-7.170),and the time from membrane rupture to delivery(OR=1.045,95%CI:1.012-1.081)are independent risk factors for intrapartum fever(all P<0.05).Anemia(OR=0.358,95%CI:0.192-0.647,P<0.05)is a protective factor for intrapartum fever.(3)Premature rupture of membranes(OR=2.138,95%CI:1.189-3.865),prolonged total labor duration(OR=1.240,95%CI:1.174-1.315),vaginitis(OR=3.353,95%CI:1.719-6.926),prolonged time from membrane rupture to delivery(OR=1.047,95%CI:1.013-1.085),meconium-stained amniotic fluid(OR=2.154,95%CI:1.357-3.466)and cervical ripening promotion(OR=3.880,95%CI:2.136-7.363)are risk factors for intrapartum fever in women receiving delivery analgesia(all P<0.05).Conclusions The influencing factors of intrapartum fever include premature rupture of membranes,labor analgesia,total labor,meconium-stained amniotic fluid,vaginitis,cervical ripening promotion,time from rupture of membranes to delivery,and anemia.Obstetricians should strengthen the monitoring of maternal temperature and the management of the labor process,pay attention to risk factors of intrapartum fever,and significantly reinforce the management of labor for women with cervical ripening promotion,labor analgesia and premature rupture of membranes to reduce postpartum fever and improve adverse maternal and infant outcomes.