非头先露早产胎膜早破42例妊娠结局  

Pregnancy outcomes of 42 patients with PPROM with nonvertex presentations

作　　者：徐元春[1] 王细先[1] 康程[1] 

机构地区：[1]北京航天总医院妇产科,100076

出　　处：《中国妇产科临床杂志》2012年第3期163-166,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨非头先露早产胎膜早破(preterm premature rupture of membranes,PPROM)的并发症、分娩方式及母婴结局。方法回顾性分析在北京航天总医院分娩的42例非头先露PPROM和178例头先露PPROM的临床资料,对两组并发症、分娩方式及母儿结局进行比较。结果非头先露PPROM在脐带脱垂、羊水过少、1min低Apgar评分、死胎死产、新生儿死亡的发生率显著高于对照组,差异有统计学意义(P值分别为<0.001、<0.001、<0.001、<0.035、<0.001)。非头先露PPROM组剖宫产率明显高于对照组(P<0.001);采取多因素Logistic回归分析,非头先露PPROM组脐带脱垂(P=0.021,OR=0.073),1min低Ap-gar评分(P=0.018,OR=0.092)的发生率显著增高,PPROM组脐带脱垂的发生率明显高于同期足月PROM组(4.1%vs0.5%),且同期非头先露PROM组脐带脱垂的发生率明显高于同期头先露PROM组(2.6%vs0.5%),差异有高度统计学意义(P<0.001)。结论非头先露PPROM是脐带脱垂、1min低Apgar评分的危险因素,剖宫产是非头先露PPROM较为安全的分娩方式,如阴道分娩需提高臀位助产技术。Objective The objective of this study was to investigate the morbidity, mode of delivery and pregnancy outcomes of patients with PPROM nonvertex presentations.Methods Data of 42 patients with PPROM with nonvertex presentations （study group） and 178 patients with PPROM with vertex presentations （control group） was analyzed retrospectively. All patients that met the study admission criteria were treated in Beijing Aerospace General Hospitals from January 2005 to December 2010.Results Statistically significant higher incidence of prolapsed umbilical cord （P0.001）, oligohydramnios（P0.001）, low 1-minute Apgar scores （≤7） （P0.001）,stillbirth （P0.035）,neonatal death （P0.001） were found in the study group compared to the control group .Logistic regression analysis showed that patients with PPROM with nonvertex presentations appear to have significantly higher risk of prolapsed umbilical cords （P=0.021, OR=0.073）, low 1-minute Apgar scores （≤7）（P=0.018,OR=0.092）compared with their vertex counterparts. The cesarean-section rate in the study group was significant higher than that in the control group（P0.001）. Significant（P0.001）） higher incidence of prolapsed umbilical cord was found in 220 patients with PPROM （n=9, 4.1%） compared to the 1 632 women with full term prom （nn=8,0.5%）. And 382 patients with nonvertex presentations with prom appear to have significantly （P0.001） higher incidence of prolapsed umbilical cords （n=10,2.6%） compared to 1 470 patients with vertex presentations with prom （n=7,0.5%） in the same time. Conclusions PPROM with nonvertex presentations appear to have a significantly higher risk of prolapsed umbilical cords and lower Apgar scores. Cesarean section maybe the safety mode of delivery for patients with PPROM with nonvertex presentations, the practicing obstetrician need to enhance technique of vaginal breech delivery.

关 键 词：非头先露 早产胎膜早破 脐带脱垂 APGAR评分 围产儿死亡 

分 类 号：R714.433[医药卫生—妇产科学]