未足月胎膜早破残余羊水量对妊娠结局的影响

Influence of residual amniotic fluid index after premature rupture of membrane on pregnancy outcome

目的探讨未足月胎膜早破(PPROM)残余羊水指数与妊娠结局的关系。方法 2013年1月至2016年3月在陆军总医院住院分娩的单胎PPROM产妇共172例,根据羊水指数(AFI)分为残余羊水过少组(AFI≤5 cm)20例、偏少组(5 cm<AFI≤8 cm)24例及正常组(8 cm<AFI<25 cm)128例,对其妊娠结局进行比较。结果 (1)残余羊水过少组分娩孕周及新生儿出生体重[(32.56±3.18)周,(1956.2±703.0)g]明显低于偏少组[34.15±2.35)周,(2341.7±585.7)g,P=0.007]及正常组[(34.37±2.19)周,(3440.5±605.1)g,P=0.005)],差异有统计学意义(P<0.01)。(2)残余羊水过少组与偏少组、正常组相比,低出生体重儿(80.0%、58.3%、50.0%)、新生儿窒息(15.0%、0.0、2.3%)、新生儿呼吸窘迫综合征(10.0%、0.0、0.8%)、1 min Apgar评分≤7分(15.0%、0.0、2.3%)、产后子宫内膜炎(10.0%、0.0、0.8%)的发生率明显更高,差异均有统计学意义(P<0.05),而残余羊水过少组、偏少组及正常组3组间剖宫产分娩(55.0%、50.0%、51.2%)、潜伏时间[(38.31±39.83)h、(32.67±45.67)h、(38.56±49.52)h]、胎儿窘迫(15.0%、8.3%、7.8%)、绒毛膜羊膜炎(5.0%、0.0、3.1%)、产后出血(10.0%、8.3%、5.5%)发生率差异无统计学意义(P>0.05)。与正常组相比,羊水量过少组新生儿窒息、低出生体重儿、1 min Apgar≤7分和新生儿呼吸窘迫综合征的危险性增加(P<0.05)。结论 PPROM残余羊水与妊娠结局关系密切,PPROM孕妇应严密监测残余羊水变化、感染及胎儿健康情况,适时终止妊娠。

Objective To investigate the correlation between residual amniotic fluid index(AFI)of premature rupture of membrane(PPROM)and pregnancy outcome. Methods Totally 172 cases of singleton pregnancy women with PPROM in the Army General Hospital(hereinafter referred to briefly as our hospital)from January 2013 to March 2016 were categorized into three groups according to the residual AFI:group of low-,mid-,and high-AFI(n=20,24 and 128respectively).Maternal and fetal outcomes were compared.Results(1)Gestational ages at delivery and fetal birth weight were significantly lower in low-AFI group[(32.56±3.18)w,(1956.2±703.0)g]than in mid-AFI[(34.15±2.35)w,(2341.7±585.7)g,P=0.007],and high-AFI group[(34.37±2.19)w,(3440.5±605.1)g,P=0.005].(2)The incidence of low birth weight infant,neonatal asphyxia,neonatal respiratory distress syndrome,Apgar scores lower than seven at 1minute after birth,and postpartum endometritis in low-AFI group(80.0%,15.0%,10.0%,15.0%,10.0%)were significant higher than in mid-AFI(58.3%,0.0,0.0,0.0,0.0),and high-AFI group(50.0%,2.3%,0.8%,2.3%,0.8%).While the incidence of cesarean delivery(55.0%,50.0%,51.2%),the time membranes ruptured till delivery[(38.31±39.83)h,(32.67±45.67)h,(38.56±49.52)h],fetal distress(15.0%,8.3%,7.8%),chorioamnionitis(5.0%,0.0,3.1%),and postpartum hemorrhage(10.0%,8.3%,5.5%)in low-,mid-,and high-AFI groups were similar(P>0.05).Compared to mid-AFI group,the incidence risk of low birth weight infant,neonatal asphyxia,Apgar scores lower than seven at 1 minute after birth and respiratory distress syndrome of newborn were higher in low-AFI group.Conclusion The residual AFI of PPROM is closely relates to the pregnancy outcome,so it should be a valuable monitoring index for PPROM just as important as infection and fetal health condition,so that pregnancy can be terminated in the best time.