1659例胎膜早破相关危险性因素及妊娠结局的分析  

Analysis of Related Risk Factors and Pregnancy Outcome of 1659 Cases of Premature Rupture of Membranes

作　　者：姜智慧 孟茜[1] 刘梅林 李菁 JIANG Zhihui;MENG Qian;LIU Meilin;LI Jing(Lianyungang Maternal and Child Health Hospital,Lianyungang 222000,China)

机构地区：[1]江苏省连云港市妇幼保健院,江苏连云港222000

出　　处：《中国医学创新》2020年第30期79-83,共5页Medical Innovation of China

基　　金：连云港市卫生科技项目面上项目(201926)。

摘　　要：目的:探讨胎膜早破的高危因素、分娩方式及对妊娠结局的影响。方法:回顾性分析2018年1月-2019年12月于本院分娩的胎膜早破病例1659例。根据其发生胎胎早破的孕龄分为未足月胎膜早破组(n=220)与足月胎膜早破组(n=1439)。观察胎膜早破发生情况;分析1659例胎膜早破原因;比较不同类型胎膜早破分娩方式、新生儿结局;分析胎膜早破中剖宫产指征。结果:胎膜早破发生率为17.9%,其中未足月胎膜早破220例,发生率为2.4%,占所有胎膜早破的13.3%;足月胎膜早破者为1439例,发生率为15.6%,占所有胎膜早破的86.7%。导致胎膜早破的原因主要为流产和引产史、巨大儿、妊娠期糖尿病、瘢痕子宫、生殖道感染、妊娠期高血压、多产、臀位、多胎妊娠、子宫肌瘤、羊水过多。其中流产和引产史492例占33.74%,远高于生殖道感染108例占7.41%,成为胎膜早破最主要的高危因素。未足月胎膜早破组剖宫产率为50.45%,高于足月胎膜早破组的27.87%,差异有统计学意义(P<0.001)。两组间胎儿窘迫发生率比较,差异无统计学意义(P>0.05)。未足月胎膜早破组新生儿窒息发生率为3.64%,明显高于足月胎膜早破组0.49%,差异有统计学意义(P<0.001)。胎膜早破中剖宫产共512例,其他因素占42.00%。结论:胎膜早破可对新生儿造成不良结局,尤其是未足月胎膜早破,流产和引产史成为胎膜早破发生的新的高危因素,应重视孕前和孕期保健,避免不必要的流产和引产操作,降低胎膜早破的发生率,减少母婴并发症。Objective:To investigate the high risk factors of premature rupture of membranes,mode of delivery and the impact on pregnancy outcome.Method:1659 cases of premature rupture of membranes delivered in our hospital from January 2018 to December 2019 were retrospectively analyzed.According to their gestational age,they were divided into preterm premature rupture of membranes group(n=220)and term premature rupture of membranes group(n=1439).The occurrence of premature rupture of membranes was observed.The causes of 1659 cases of premature rupture of membranes were analyzed.Different types of premature rupture of membranes and neonatal outcomes were compared.Analysis of indications of cesarean section in premature rupture of membranes.Result:The incidence of premature rupture of membranes was 17.9%,including 220 cases of preterm premature rupture of membranes,the incidence was 2.4%,accounting for 13.3%of all premature rupture of membranes.There were 1439 full-term premature rupture of membranes,the incidence was 15.6%,accounting for 86.7%of all premature rupture of membranes.The main causes of premature rupture of membranes are history of abortion and induced labor,macrosomia,gestational diabetes,scar uterus,reproductive tract infection,gestational hypertension,fertility,breecause,multiple pregnancy,uterine fibroids and excessive amniotic fluid.The 492 cases of abortion and induced labor accounted for 33.74%,far higher than the 108 cases of genital tract infection accounted for 7.41%,which became the most important risk factor of premature rupture of membranes.The cesarean section rate of preterm premature rupture of membranes group was 50.45%,which was higher than 27.87%of term premature rupture of membranes group,the difference was statistically significant(P<0.001).There was no significant difference in the incidence of fetal distress between the two groups(P>0.05).The incidence of neonatal asphyxia in preterm premature rupture of membranes group was 3.64%,which was significantly higher than 0.49%of term premature r

关 键 词：胎膜早破 早产胎膜早破 危险因素 分娩方式 妊娠结局 

分 类 号：R714.433[医药卫生—妇产科学]