胎盘早剥的危险因素:早产胎膜早破、子宫内感染和羊水过少

OBJECTIVE: To examine whether preterm premature rupture of membranes (PROM), intrauterine infection, and oligohydramnios are risk factors for placental abruption. METHODS: Data for this retrospective cohort study were derived from the 1988 National Maternal and Infant Health Survey (N=11,777). Association between abruption and these clinical risk factors was expressed as relative risk (RR) and 95%confidence interval (CI), with multivariate adjustment for potential confounders. RESULTS: The overall incidence of abruption was 0.87%. The risk of abruption was 3.58-fold higher (95%CI 1.74-7.39)among women with preterm PROM (2.29%) compared with women with intact membranes (0.86%). The rates of abruption among women with and without intrauterine infection were 4.81%and 0.83%, respectively (RR 9.71, 95%CI 3.23-29.17). However, oligohydramnios was not associated with abruption (1.46%compared with 0.87%; RR 2.09, 95%CI 0.92-5.31). Compared with women with intact membranes, the RR for abruption among preterm PROM and whose membranes were ruptured for 24-47 hours and 48 hours or more before delivery, respectively, were 2.37 (95%CI 0.99-9.09), and 9.87 (95%CI 3.57-27.82). When preterm PROM was accompanied by intrauterine infections, the RR for abruption was 9.03 (95%CI 2.80-29.15) compared with women with intact membranes and no infections. Similarly, preterm PROM accompanied by oligohydramnios conferred over a 7.17-fold risk (95%CI 1.35-38.10) for abruption compared with women with neither of these 2 conditions. CONCLUSION: Women presenting with preterm PROM are at increased risk of developing abruption, with the risk being higher either in the presence of intrauterine infections or oligohydramnios. Physicians managing patients with preterm PROM should be aware that these patients are at increased risk of developing abruption after 24 hours following preterm PROM.

经阴道分娩与剖宫产产妇的发病率

OBJECTIVE: To describe postpartum maternal morbidity associated with mode of delivery in term, singleton pregnancies. METHODS: The Magee Obstetric Medical and Infant database was examined for the years 1995 to 2000. Patients were grouped into 6 types of delivery mode: spontaneous vaginal delivery, operative vaginal delivery, primary cesarean delivery without trial of labor, primary cesarean delivery with trial of labor, repeat cesarean delivery without trial of labor, and repeat cesarean delivery with trial of labor. Multivariable logistic regression provided odds ratios and 95%confidence intervals (CI) for morbidity by delivery mode adjusted for demographic characteristics and comorbidities. Spontaneous vaginal delivery was used as the referent group (odds ratio = 1). RESULTS: Of 32,834 subjects, 27,178 had vaginal delivery (operative = 4,908; spontaneous = 22,270) and 5,656 had cesarean delivery. Third-or fourth-degree lacerations occurred in 1,733 (7.8%)-women who had spontaneous vaginal delivery compared with 1,098 (22.3%) who had operative vaginal delivery. Overall, 523 women (1.6%) had endometritis. Compared with spontaneous vaginal delivery, primary cesarean delivery with trial of labor conferred a 21.2-fold increased risk of endometritis (95%CI 15.4, 29.1). Even without trial of labor, women after primary cesarean delivery were 10.3 times more likely to develop endometritis (95%CI 5.9, 17.9) than after spontaneous vaginal delivery. The risk of transfusion was highest in women delivered by primary cesarean after labor, 4.2 times higher (95%CI 1.8, 10.1) than spontaneous vaginal delivery. The risk of pneumonia was 9.3 times higher (95%CI 3.4, 25.6) after repeat cesarean delivery with labor. Deep venous thromboses occurred in 15 (0.1%) after spontaneous vaginal delivery, 2 (0.04%) after operative vaginal delivery, and 12 (0.2%) after cesarean delivery. CONCLUSION: Compared with spontaneous vaginal delivery, cesarean delivery is associated with increased risks of endometritis, the need for transfusion, and pneumonia; however, these rates are lower than reported previously.