产时发热的危险因素分析  

Analysis of the risk factors for intrapartum fever

作　　者：王颖[1] 石慧峰 杨怡珂 张龑[1] 魏瑗[1] 赵扬玉[1] WANG Ying;SHI Hui-feng;YANG Yi-ke;ZHANG Yan;WEI Yuan;ZHAO Yang-yu(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科,北京100191

出　　处：《中国实用妇科与产科杂志》2024年第10期1036-1041,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划(2021YFC2700700)。

摘　　要：目的寻找产时发热的危险因素,探讨产时发热的优化管理方案。方法采用前瞻性队列研究方法,纳入2021年1月至12月在北京大学第三医院分娩孕妇。纳入标准:单胎、头位、自然临产或引产临产,分娩孕周≥34周。排除标准:临产前存在发热或感染性疾病,孕妇拒绝阴道分娩,瘢痕子宫,严重妊娠期合并症和并发症等存在阴道分娩禁忌的孕妇,死胎或胎儿存在明显的结构或染色体异常。分析孕妇自身情况、产程处理、分娩镇痛等因素对产时发热的影响。临产后至胎儿胎盘娩出前体温≥38℃定义为产时发热。结果共纳入3870例孕妇,存在产时发热的孕妇共200例,占5.17%。孕妇的一般情况如年龄、孕前体重指数(BMI)、孕期体重增长、分娩孕周,合并症情况如妊娠期高血糖、甲状腺功能异常、自身免疫性疾病,胎儿情况如性别、出生体重等因素与产时发热无明显相关。与非发热组相比,发热组中初产妇(92.00%vs.78.34%,P=0.001)、妊娠期高血压疾病(20.00%vs.12.89%,P=0.004)、B族链球菌阳性(group B Streptococcus,GBS)(4.50%vs.1.69%,P=0.004)、引产临产(47.00%vs.30.74%,P<0.001)、临产前人工破膜(19.00%vs.7.66%,P<0.001)、分娩镇痛(48.50%vs.35.97%,P<0.001)的比例增高,总产程[8.04(4.48,14.38)h vs.5.75(1.37,13.38)h]、破膜至分娩时间[11.00(7.59,15.00)h vs.8.83(5.50,13.40)h]、产前住院时间[44.16(18.24,76.32)h vs.39.57(38.71,40.29)h]较长。分层分析显示,引产临产、临产前人工破膜、产前住院时间延长还与发热程度相关。结论人工干预引产时需要慎重考虑引产指征和评估引产获益,并重视缩短引产时间、提高引产成功率、避免人工破膜等人工干预措施,可能是进一步降低产时发热率、改善母儿预后的重要措施。产时规范治疗GBS并完善GBS药敏监测,可能在减少药物滥用的基础上进一步降低产时发热的发生率。Objective To analyze the risk factors of intrapartum fever and explore the optimal management of intrapartum fever.Methods This was a prospective cohort study,which included pregnant women who delivered in the Peking University Third Hospital from January to December 2021.Inclusion criteria:singleton,cephalic presentation,gestational weeks of delivery≥34 weeks;exclusion criteria:pregnant women who had fever or infectious diseases before delivery,refused vaginal delivery,had scar uterus,had complications and contraindications to vaginal delivery.Significant structural or chromosomal abnormalities exist in the stillbirth or fetus.To analyze the influence of pregnant women's situation,labor process mangment,labor analgesia and other factors on intrapartum fever.Intrapartum fever was defined as the temperature≥38℃from labor to delivery.Results Totally 3870 cases were included.There were 200 cases with intrapartum fever,accounting for 5.17%.There was no significant association with intrapartum fever such as age,perpregancy body mass index(BMI),weigh gain during pregnancy,gestational weeks of delivery,comborbidities such as hyperglycemia disease,thyroid dysfuction,autoimmune siseases,fetal conditions,fetal conditions such as sex,birth weight.Compared with the non-fever group,the fever group got higher proportion of primipara(92.00%vs.78.34%,P<0.001),hypertensive disorders(20.00%vs.12.89%,P=0.004),group B Streptococcus(GBS)(4.50%vs.1.69%,P=0.004),induced labor(47.00%vs.30.74%,P<0.001),artificial rupture of membranes before labor(19.00%vs.7.66%,P<0.001),labor analgesia(48.50%vs.35.97%,P<0.001),the total labor duration[8.04(4.48,14.38)h vs.5.75(1.37,13.38)h],the time from rupture of membranes to delivery[11.00(7.59,15.00)h vs.8.83(5.50,13.40)h],and the time of antenatal hospitalization[44.16(18.24,76.32)h vs.39.57(38.71,40.29)h].Stratified analysis showed that induced labor,artificial rupture of membranes,and prolonged antenatal hospitalization were also related to the degree of fever.Conclusions It is necessary to

关 键 词：产时发热 分娩镇痛 GBS阳性 人工干预 住院时间 

分 类 号：R714.3[医药卫生—妇产科学]