产前发热的早产孕妇合并组织学绒毛膜羊膜炎的相关因素分析  

Related factors of histologic chorioamnionitis in preterm birth in pregnant women with prenatal fever

作　　者：林楠[1,2] 夏缘青 华人意 LIN Nan;XIA Yuan-qing;HUA Ren-yi(The International Peace Maternity and Child Health Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai,200030 China;Shanghai Key Laboratory of Embryo Original Diseases,Shanghai,200030,China)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院,上海200030 [2]上海市胚胎源性疾病重点实验室

出　　处：《中国妇幼保健》2023年第3期488-492,共5页Maternal and Child Health Care of China

基　　金：国家重点研发计划(2018YFC1004600)。

摘　　要：目的 探讨发生产前发热的早产孕妇中组织学绒毛膜羊膜炎(HCA)对母婴结局的影响及HCA的相关因素。方法 选取2018年1月—2020年12月在上海交通大学医学院附属国际和平妇幼保健院早产、单胎活产分娩,且产前测量体温≥37.5℃的孕妇220例,根据胎盘病理检查结果分为HCA组(101例)和对照组(119例)。比较两组孕妇的各项临床特征及早产儿结局,并通过多因素logistic回归模型分析HCA的相关因素。结果 HCA组早产儿先天性感染和败血症发生率明显高于对照组(均P<0.05)。HCA组孕妇胎膜早破的发生率高于对照组,且发生胎膜早破的孕周小于对照组(均P<0.05)。两组孕妇在发热时距已发生胎膜早破的间隔时间比较差异有统计学意义(P<0.05),24 h<发热距胎膜早破时间≤48 h(OR=3.603,95%CI:1.027~12.644)和发热距胎膜早破时间>48 h(OR=6.201,95%CI:1.729~22.238)是发生HCA的相关因素。结论 HCA造成早产儿的不良结局,密切监护胎膜早破潜伏时间,对发热的未足月胎膜早破孕妇破水时长超过24 h或48 h应积极进行产科干预,以改善早产儿预后。Objective To investigate the effect of histologic chorioamnionitis(HCA) on maternal and infantile outcomes in preterm pregnant women with prenatal fever and the related factors of HCA.Methods From January 2018 to December 2020,220 pregnant women who delivered preterm and single birth alive with temperature 37.5 ℃ or more than 37.5 ℃ were selected and divided into HCA group(101 cases) and control group(119 cases) according to the results of placental pathology. The clinical characteristics and premature outcome of pregnant women in the two groups were compared, and the related factors of HCA were analyzed by multivariate logistic regression model.Results The incidence rates of congenital infection and neonatal sepsis in HCA group was significantly higher than those in control group(P<0.05).The incidence rate of premature rupture of membranes in HCA group was higher than that in control group, and the gestational age of premature rupture was smaller than that in control group(P<0.05).There were significant differences in the interval between the onset of fever and the occurrence of premature rupture of membranes between the two groups(P<0.05).24 Hours48 hours(OR=6.201,95%CI:1.729-22.238) were associated with HCA.Conclusion HCA causes the adverse outcome of premature infants.The latent time of premature rupture should be closely monitored, and obstetric intervention should be actively carried out for pregnant women with preterm premature rupture of membranes with fever whose rupture duration exceeds 24 hours or 48 hours to improve the prognosis of premature infants.

关 键 词：组织学绒毛膜羊膜炎 产前发热 早产 胎膜早破 

分 类 号：R714.25[医药卫生—妇产科学]