双胎未足月胎膜早破122例临床分析

目的:探讨双胎未足月胎膜早破(PPROM)的临床特点和妊娠结局。方法:回顾性分析双胎PPROM122例(研究组)及同期随机抽取的单胎PPROM183例(对照组),探讨两组胎膜早破发生率、发病孕周、期待治疗、新生儿预后等情况。结果:双胎妊娠PPROM发生率为21.0%,显著高于单胎妊娠PPROM发生率(3.5%)(P0.05);研究组早产儿体重明显低于对照组,窒息率明显高于对照组(P0.05);研究组胎膜早破孕周、终止妊娠孕周均早于对照组,研究组34周发生胎膜早破者期待时间明显短于对照组(P0.05)。结论:双胎妊娠易发生胎膜早破、早产、新生儿窒息,期待治疗时间短,应积极预防,出现胎膜早破积极对症治疗,选择合适的分娩方式,改善新生儿结局。     

未足月胎膜早破不同孕周及潜伏期长短对妊娠结局的影响

目的:探讨未足月胎膜早破(PPROM)破膜孕周及不同潜伏期长短对妊娠结局的影响及临床意义.方法:回顾性分析148例孕28～36+6 周PPROM孕产妇和新生儿的临床资料.结果:孕28～33+6 周PPROM组新生儿呼吸窘迫、缺血缺氧性脑病和死亡及绒毛膜羊膜炎均明显高于孕34～36+6 周PPROM组,孕28～33+6 周PPROM组潜伏期在48小时以内的新生儿呼吸窘迫、缺血缺氧性脑病和死亡均高于潜伏期在48小时以后者,差异均有统计学意义(P<0.05).孕34～36+6 周PPROM组潜伏期在48小时以内者的孕产妇与潜伏期在48小时以后者相关并发症发生率差异无统计学意义,结论:对孕28～33+6 周PPROM应采取促胎肺成熟和预防感染等措施,延长孕周,适时终止妊娠;而孕34～36+6周PPROM胎儿肺成熟者应在破膜48小时以内终止妊娠.     

孕34周前未足月胎膜早破353例临床分析

目的:分析妊娠24～33~(+6)周未足月胎膜早破(PPROM)破膜孕周、期待治疗时间及残余羊水量与母儿结局的关系,为胎膜早破患者的临床治疗及处理提供数据参考。方法:回顾分析2015年1月至2019年12月于南京医科大学第一附属医院产科住院分娩的353例孕24～33~(+6)周PPROM孕产妇及新生儿的临床资料。分别根据破膜时孕周、期待治疗时间及残余羊水量分组,探讨上述因素与母儿结局的关系。结果:不同破膜孕周孕产妇期待治疗时间有明显差异,且围产儿出生体重、NICU住院时间、各并发症发生率(除外新生儿呼吸窘迫综合征)、围产儿死亡率比较差异均有统计学意义(P0.05)。期待治疗时间≥72h组,围产儿出生体重增加,NICU住院时间缩短,与72h组比较差异有统计学意义(P0.05)。不同残余羊水量3组间期待治疗时间、剖宫产分娩率、新生儿窒息率方面比较,差异有统计学意义(P0.05)。结论:破膜孕周是影响围产儿结局的最重要因素,恰当的期待治疗能改善围产儿预后,且不增加孕产妇并发症发生率。     

未足月胎膜早破期待治疗后发生新生儿败血症独立危险因素分析

目的探讨24～33~(+6)周未足月胎膜早破(PPROM)孕妇期待治疗后发生新生儿败血症的独立危险因素。方法回顾性分析中国医科大学附属盛京医院2016年1月至2018年4月收治的24～33~(+6)周880例PPROM孕妇,根据新生儿是否患有新生儿败血症分为败血症组(118例)和无败血症组(762例),比较两组孕妇的临床资料,通过多因素Logistic分析期待治疗过程中新生儿败血症的独立危险因素。结果单因素分析显示,败血症组的早产史、行宫颈环扎、行体外受精-胚胎移植(IVF-ET)受孕、母体心率100次/min、期待治疗时间5d及临产羊水量减少(深度1cm或指数2cm)的比例明显高于无败血症组,差异有统计学意义(P0.05);孕周(入院或临产孕周)分布及入院白细胞(WBC)计数两组差异有统计学意义(P0.05)。多因素Logistic回归分析显示,IVF-ET、期待治疗时间5d、临产孕周为28～31~(+6)周及临产羊水指数2cm是发生新生儿败血症的独立危险因素(OR1)。结论 IVF-ET、期待治疗时间5d、临产孕周为28～31~(+6)周及临产羊水指数2cm是发生新生儿败血症的独立危险因素。对于IVF-ET术后尤其是孕周相对较小的胎膜早破患者,加强孕期管理、羊水监测,适时期待治疗,可有效降低新生儿败血症的发生率。     

双胎妊娠结局及分娩时机与分娩方式对新生儿窒息的影响

目的:探讨双胎妊娠结局及不同分娩时机与分娩方式对新生儿窒息的影响。方法:回顾性分析本院462例双胎妊娠孕妇晚期流产及分娩结局资料,以1分钟Apgar评分≤7分为标准诊断新生儿窒息,对比分析不同孕周的晚期流产率,及在不同分娩孕周采用不同分娩方式的新生儿窒息率。结果:(1)双胎妊娠孕妇孕28周前流产42例,主要集中于孕26～27~(+6)周(18例)。(2)孕28周后分娩的活产新生儿共834例,其剖宫产新生儿窒息率(2. 16%)低于阴道分娩(12. 77%)(P0. 05),其中孕28～29~(+6)、孕32～33~(+6)周剖宫产与阴道分娩的新生儿窒息率差异有统计学意义(P0. 05)。新生儿窒息率在孕36～37~(+6)周(0. 44%)明显低于其他孕周(P0. 05)。(3)大胎儿和小胎儿的剖宫产新生儿窒息率均低于阴道分娩(P0. 05),剖宫产中大胎儿新生儿窒息率低于小胎儿(P0. 05)。剖宫产中大胎儿在孕34～35~(+6)周的新生儿窒息率(0)明显低于其他孕周(P0. 05),剖宫产中小胎儿在孕36～37~(+6)周的新生儿窒息率(0)明显低于其他孕周(P0. 05)。结论:双胎妊娠应加强孕期监护,防止晚期流产的发生。双胎妊娠无明显并发症时可尽量延长孕周至36～37~(+6)周,但不宜过迟,采取剖宫产方式可降低新生儿窒息率的发生。     

早产合并胎膜早破71例分析

目的 探讨早产合并胎膜早破(preterm premature rapture of membranes，PPROM)的易发因素、临床处理及妊娠结局。方法 对71例PPROM进行回顾性分析。结果 77．47％的PPROM有易发因素存在，孕28～34^ 6周PPROM新生儿发病率明显高于孕35～36^ 6周者。结论 对于孕28～34^ 6周PPROM宜采取期待疗法，以减少新生儿合并症的发生。     

双胎终止妊娠时机及不同分娩方式对围生儿不良结局的影响

目的探讨双胎不同分娩方式对围生儿不良结局的影响。方法 2013年1月至2015年12月在北京妇产医院进行产检并分娩的双胎无并发症病例325例,依据不同分娩方式和孕周(28~31周、32~33周~(+6)、34~36周~(+6)、37~38周~(+6))分组比较妊娠结局,并分析第一胎为头位的双绒毛膜双胎妊娠结局。结果 (1)双胎剖宫产率占80.62%,剖宫产和阴道分娩的出血率分别是54.58%和26.98%,两组比较,差异有统计学意义,新生儿窒息率在剖宫产和阴道分娩分别为14.12%和15.87%,差异无统计学意义;(2)在32周的病例中,阴道分娩组的新生儿窒息率和围生儿死亡率分别为66.67%和33.33%均高于剖宫产组的15.38%和6.67%,差异有统计学意义;(3)剖宫产组的产后出血率高于阴道分娩组,差异有统计学意义;(4)32周剖宫产和阴道分娩的双绒毛膜双胎其新生儿窒息及围生儿死亡率均无统计学意义。结论 32周的双胎阴道分娩不增加围生儿不良妊娠结局;32周双胎的分娩方式需要更多研究指导临床。     

孕34周前胎膜早破早产病例中组织学诊断绒毛膜羊膜炎与母婴结局的临床分析

目的探讨在未足月胎膜早破(PPROM)患者中发生组织学绒毛膜羊膜炎(HCA)的临床特征及新生儿结局。方法 2010年1月至2015年1月湖北省妇幼保健院共收治214例PPROM患者,均为单胎妊娠且孕28~33+6周,以产后的胎盘病理为依据分为HCA组(145例)及无HCA组(69例)。比较两组的临床特征、各检测指标、新生儿结局,同时采用多因素Logistic回归分析对发生HCA的危险因素进行分析。结果与无HCA组比较,HCA组的破膜孕周显著减小,其分娩时C反应蛋白(CRP)水平、入院时羊水过少、剖宫产率均显著增高;而新生儿出生的孕周及体重显著降低,新生儿1min Apgar评分7分、支气管肺发育不良、新生儿肺炎、早发型败血症、颅内超声异常的发生率及围产儿病死率也均显著增高,差异均有统计学意义(P0.05)。经多因素Logistic回归分析结果显示孕妇羊水过少、破膜孕周32周、破膜至临产的时间为48~168h、分娩时CRP水平8mg/L是诱发HCA的危险因素(P0.05)。结论发生HCA后能使PPROM新生儿多种疾病的发生率及新生儿病死率显著上升;而患者羊水过少、破膜孕周32周、潜伏期48~168h、分娩时CRP水平8mg/L均为诱发HCA的相关因素。     

有无明显诱因致早产合并胎膜早破的临床对比分析

目的:探讨有、无明显诱因导致早产合并胎膜早破(PPROM)对母儿的影响.方法:收集2004年11月至2012年1月早产合并PPROM 494例患者的临床资料进行回顾性分析,将287例有明显诱发因素的患者作为PPROM(A)组,原因不明早产合并PPROM 207例为PPROM(B)组,比较两组患者一般情况、分娩方式及妊娠结局.结果:①PPRoM(A)组孕妇平均年龄及既往不良孕产史发生率均高于PPROM(B)组(29.72±4.81岁vs 28.50±4.49岁,P＜0.05;4.9％ vs0,P ＜0.05);分娩孕周显著低于PPROM (B)组(33.01±2.40周vs 34.01±2.29周,P＜0.01).②PPROM(A)组阴道顺产率明显低于PPROM(B)组(33.1％ vs 73.4％,P＜0.01);剖宫产率则显著升高(63.8％ vs 25.6％,P＜0.01).③PPROM(A)组孕妇总的并发症发生率高于PPROM(B)组(31.7％ vs 21.3％,P＜0.01),其中,PPROM(A)组羊膜腔感染发生率较PPROM(B)组显著升高(9.1％ vs 0,P＜0.01).④PPROM (A)组新生儿体重、1分钟Apgar评分均显著低于PPROM(B)组(P＜0.01);新生儿窒息率则高于PPROM(B)组(P＜0.05).两组其他方面比较差异无统计学意义(P＞0.05).结论:有明显诱因致早产合并PPROM者,母儿患病率相对较高.孕妇年龄、既往不良孕产史及母亲健康状况可能也与妊娠结局有关.针对不同病因,应采取不同处理措施,以减少母儿并发症.     

早产胎膜早破的妊娠结局分析

目的探讨早产胎膜早破(preterm premature rupture of membranes,PPROM)的妊娠结局.方法对48例PPROM进行回顾性分析.结果48例PPROM的潜伏期为1 h～56 h30 min,平均为18 h2 min.64.6%的PPROM有易发因素存在.孕28～35周与孕35～37周间,PPROM分娩方式的比较,差异无显著性的意义(P＞0.05).孕28～35周PPROM新生儿发病率和死亡比明显高于孕35～37周者(P＜0.01).3例新生儿死亡均发生在孕30周前.结论对于孕28～35周PPROM宜采取期待疗法,以减少新生儿合并症的发生.对于孕周小者,尽量延长孕周至30周以上,以降低新生儿死亡比.     

肾上腺糖皮质激素对双胎围产儿预后的影响

目的 探讨肾上腺糖皮质激素对双胎妊娠围产儿的作用。方法 56例双胎妊娠孕妇根据是否应用糖皮质激素分成两组,实验组:18例,于分娩前1周到24小时之间曾应用糖皮质激素;对照组:38例,在该时间内未应用糖皮质激素。比较两组围产儿预后间的差别。结果 在分娩孕周≤34周时,实验组的新生儿呼吸窘迫症的发病率和围产儿死亡率明显低于对照组(P<0.05);在孕周>34周时,无一例发生新生儿呼吸窘迫症,围产儿死亡率在实验组反而高于对照组(P<0.05);新生儿窒息的发生率在两组之间无明显的差别。结论 双胎妊娠可能在34周或以前分娩者,肾上腺糖皮质激素可降低新生儿呼吸窘迫症的发生率和围产儿死亡率;在34周以后分娩者,肾上腺糖皮质激素对改善围产儿预后无效。     

Preterm Prelabour Rupture of Membranes: Effect of Latency on Neonatal and Maternal Outcomes

ObjectivesTo compare risks of infection and prematurity-related outcomes according to latency periods among women with preterm prelabour rupture of membranes (PPROM).MethodsWomen with PPROM occurring between 24+0 and 36+6 weeks of gestation were identified from a provincial population-based perinatal database in Nova Scotia. The primary outcomes included composite variables for serious maternal and neonatal infectious morbidity and neonatal prematurity-related morbidity. Logistic regression was used to quantify the relationship between latency period (< 24 hours, 24 hours to < 48 hours, 48 hours to < 7 days, and ≥ 7 days) and maternal and neonatal outcomes. Separate analyses were conducted for gestational age groups 24+0 to 33+6 weeks and 34+0 to 36+6 weeks.ResultsThere were 4329 women included in the cohort. The composite variables representing serious maternal or neonatal infectious morbidity were not significantly associated with latency for either gestational age group. For PPROM occurring at gestational ages of 24+0 to 33+6 weeks, the odds of neonatal prematurity-related morbidity were significantly decreased at the latency periods of 48 hours or more compared with < 24 hours latency. For PPROM at 34+0 to 36+6 weeks of gestation, the odds of prematurity-related morbidity at 48 hours to < 7 days latency was decreased compared with latencies < 24 hours (OR 0.4; 95% CI 0.2 to 0.8).ConclusionPostponing delivery following PPROM may contribute to less prematurity-related morbidity, even close to term, without putting mother or neonate at substantial risk for serious infectious morbidity. Generalization of these findings to other obstetric populations should be informed by the underlying risk of infection.     

辅助生殖技术单胎妊娠结局分析

目的:研究辅助生殖技术(ART)与自然受孕两种不同受孕方式单胎妊娠的妊娠结局。方法:回顾分析2009年1月1日至2017年12月31日在广州医科大学附属第三医院住院分娩的妊娠≥20周的单胎妊娠病例资料。按受孕方法分为ART组及自然妊娠组,分析两组母儿结局,再按是否为高龄妊娠,比较ART组及自然妊娠组的母儿结局。结果:ART组孕妇的平均年龄、初产妇、定期产检、非足月胎膜早破(PPROM)、羊水量异常、子痫前期、妊娠期高血压、妊娠合并血小板减少症、妊娠期糖尿病、糖尿病合并妊娠、前置胎盘、胎盘植入/粘连、产后出血、剖宫产分娩、产钳/吸引产助产、人工剥离胎盘、药物/机械性引产、流产、胎儿窘迫及胎儿为男性发生率均高于自然妊娠组,ART组的住院天数更长,分娩孕周更低,转诊重症监护病房(ICU)、急性器官衰竭发生风险较低,ART组围产儿平均体重高于自然受孕组。高龄妊娠孕妇中,ART组的妊娠期糖尿病、剖宫产分娩发生风险增加。非高龄妊娠孕妇中,ART组子痫前期、妊娠期高血压、妊娠期糖尿病、糖尿病合并妊娠、流产、PROM、羊水量异常、前置胎盘、胎盘植入/粘连、产后出血、胎儿窘迫、人工剥离胎盘、药物/机械性引产发生风险增加。ART组较自然妊娠组钳产/吸引产风险均增加,产妇转诊ICU及非规律产检发生风险均降低,差异均有统计学意义(均P<0.05)。结论:ART受孕单胎妊娠并发症及新生儿不良结局发生率高于自然妊娠组孕妇,但其更注重孕期产检;在非高龄妊娠孕妇中,ART组母儿不良结局风险增加,而高龄妊娠孕妇中,ART组母儿不良结局风险增加不明显。     

单胎妊娠短子宫颈孕妇不同方式治疗后的临床结局及其影响因素分析

目的探讨不同子宫颈长度、不同诊断孕周的单胎妊娠短子宫颈孕妇,接受不同方式治疗后妊娠结局的差异并分析其影响因素。方法收集2018年1月1日至12月31日于北京大学第一医院妇产科产前检查,妊娠12~33周+6超声检查诊断为短子宫颈(≤25 mm)的单胎妊娠孕妇435例的临床资料,进行回顾性队列分析。435例短子宫颈孕妇中,子宫颈长度<10 mm 21例,≥10 mm 414例;诊断孕周<24周106例,24~29周+6104例,≥30周225例。根据治疗方式不同分为单纯休息组、孕酮组、环扎组,比较不同子宫颈长度、不同诊断孕周下3组孕妇的孕37周前分娩率、34周前分娩率、新生儿出生体重、新生儿不良结局等妊娠结局,并分析其影响因素。结果(1)短子宫颈的发生率为7.07%(435/6155),其中,诊断孕周<24周106例(1.72%,106/6155)、24~29周+6104例(1.69%,104/6155)、≥30周225例(3.66%,225/6155)。(2)子宫颈长度<10 mm的21例短子宫颈孕妇中,单纯休息组8例,孕酮组1例,环扎组12例。单纯休息组和环扎组的中位分娩孕周[分别为28.5周(25.0~40.0周)、37.0周(28.0~40.0周),U=18.000,P=0.020]、新生儿出生体重[分别为1245 g(630~3830 g)、2648 g(1560~3830 g),U=19.500,P=0.028]分别比较,差异均有统计学意义。环扎组的新生儿不良结局优于单纯休息组(分别为3/12、6/8),但两组比较,差异无统计学意义(P=0.065);(3)子宫颈长度≥10 mm且诊断孕周<24周的96例短子宫颈孕妇中,单纯休息组36例,孕酮组26例,环扎组34例,3组的分娩孕周、校正后的孕37周前分娩率、孕34周前分娩率、新生儿出生体重、新生儿不良结局分别比较,差异均无统计学意义(P均>0.05)。多因素回归分析显示,辅助生殖技术助孕(OR=11.97,95%CI为1.88~76.44,P=0.009)、感染(OR=46.03,95%CI为5.12~413.58,P=0.001)、羊膜腔内絮状沉积物(OR=9.87,95%CI为1.69~57.60,P=0.011)、妊娠期短子宫颈史(OR=7.24,95%CI为1.04~50.24,P=0.045)为早产的独立危险因素。(4)子宫颈长度≥10 mm且诊断孕周为24~29周+6的95例短子宫颈孕妇中,单纯休息组52例、孕酮组34例、子宫颈环扎术组9例。各治疗组的分娩孕周、孕37周前分娩率、孕34周前分娩率、新生儿出生体重和新生儿不良结局分别比较,差异均无统计学意义(P均>0.05)。感染是早产的独立危险因素(OR=56.40,95%CI为4.67~680.61,P=0.002)。(5)子宫颈长度≥10 mm且诊断孕周≥30周的223例短子宫颈孕妇中,孕34周前分娩率为6.3%(14/223),妊娠结局良好。各治疗组的分娩孕周、孕37周前分娩率、孕34周前分娩率、新生儿出生体重和新生儿不良结局分别比较,差异均无统计学意义(P均>0.05)。感染(OR=10.91,95%CI为2.21~53.96,P=0.003)和早产史(OR=8.63,95%CI为1.25~59.65,P=0.029)是早产的独立危险因素。结论短子宫颈是妊娠期较常见的并发症,子宫颈长度<10 mm的短子宫颈孕妇行子宫颈环扎术治疗的结局优于单纯休息和孕酮治疗;子宫颈长度≥10 mm的短子宫颈孕妇行孕酮及子宫颈环扎术治疗与单纯休息相比,妊娠结局无明显差异。感染、羊膜腔内絮状沉积物、辅助生殖技术助孕、妊娠期短子宫颈史、早产史是短子宫颈孕妇早产的独立危险因素。     

Outcomes after expectant management of extremely preterm premature rupture of the membranes

OBJECTIVE: This study was undertaken to assess contemporary outcomes in pregnancies managed expectantly after extremely preterm premature (< or =24 weeks) premature rupture of the membranes (EPPROM). STUDY DESIGN: We queried antepartum and ultrasound databases for patients with EPPROM. Data on pregnancy outcome and short-term neonatal outcomes were collected. RESULTS: Forty-six patients with EPPROM were studied. Patients were hospitalized at 24 weeks' gestation and given antibiotics and antenatal steroids. Median gestational age at PPROM was 22.0 weeks (range 16.9-24 weeks); 43 (93%) elected expectant management, 2 of whom later had an intrauterine fetal death. Median latency period to delivery was 13 days (range 0-96 days), with mean gestational age at delivery of 25.8+/-3.4 weeks. Overall survival was 47% (27 of 57 infants), after a median hospital stay of 71 days (range 17-209 days). Ten (37%) of the survivors have serious sequelae. CONCLUSION: Although significant pregnancy prolongation after previable PPROM occurs in many cases, neonatal outcomes remain poor.     

妊娠34周前胎膜早破的处理

妊娠34周前胎膜早破因胎肺不成熟、并发症多、妊娠结局较差,处理起来比较棘手。临床上应把握未足月胎膜早破（PPROM）处理的总体原则：一旦感染的风险超过早产并发症的风险,应考虑终止妊娠。孕周大小是决定PPROM处理方案的第一要素。根据不同的孕周,制定不同的处理策略。     

Clinical significance and outcome of preterm prelabor rupture of membranes: population-based study

OBJECTIVE: To evaluate maternal characteristics and neonatal and maternal birth outcome in cases of prelabor rupture of membranes (PPROM) in a non-selected parturient population. STUDY DESIGN: The study population consisted of 5660 singleton preterm births (24-36 weeks gestation) occurring between 1988 and 1997 at the Soroka University Medical Center in Israel. Parturients with no prenatal care were excluded from the study. A cross-sectional study was designed between two groups. The study group consisted of patients with PPROM (n=968) and the comparison group consisted of patients without PPROM (n=4692). The data were analyzed by SPSS package. Information was obtained using a computerized database based on detailed obstetrical records. Logistic regression was used to assess the contribution of different risk factors to PPROM. RESULTS: PPROM was associated with a significantly lower gestational age (24-32 weeks) and birth weight (<2500 g) than those with intact membranes. The rates of chorioamnionitis and urinary infection were found significantly higher in the PPROM group compared with women without PPROM (16.5 vs. 2.7%; 5.1 vs. 3.3%, respectively) (P<0.001). The rate of endometritis and bacteremia in the postpartum period were significantly higher in women with PPROM compared with controls 2.8 vs. 1.4%, (P=0.003) and 9.4 vs. 5%, (P=0.001), respectively. Total perinatal mortality rates were significantly higher in the group without PPROM 10.5 vs. 7.2% (P=0.01), however, rates of postpartum death were higher in the PPROM group 5.5 vs. 4% (P<0.01). When adjusted for recognized risk factors using logistic regression analysis, infection of amniotic fluid (OR=6.6) and genito-urinary tract infection (OR=1.64) remained the independent risk factors associated with PPROM. CONCLUSIONS: Infectious morbidity in patients with preterm prelabor rupture of membranes and preterm delivery remained an important risk factor for obstetrical and neonatal complications.     

妊娠期糖尿病合并未足月胎膜早破与阴道微生物感染及妊娠结局的相关性

目的:探讨妊娠期糖尿病（gestational diabetes mellitus,GDM）合并未足月胎膜早破（preterm premature rupture of membranes,PPROM）与阴道微生物感染及妊娠结局的相关性。方法:选取2019年6月—2020年6月在我院分娩的GDM合并PPROM的产妇为研究组（n=64）,选取同期在我院分娩的正常产妇为对照组（n=50）。2组产妇均在入组时进行分泌物标本收集,取阴道分泌物用于B族链球菌（GBS）、细菌性阴道病（BV）及假丝酵母菌（CM）的检测,取宫颈分泌物进行解脲支原体（UU）及衣原体（CT）的检测。并记录患者阴道微生物感染情况及妊娠结局。结果:2组GBS、UU及CT感染情况差异有统计学意义（均P<0.05）,BV、CM感染情况差异无统计学意义（均P>0.05）,GDM合并PPROM与GBS、UU及CT感染呈正相关（列联系数r分别为0.293、0.202和0.189）,且与GBS感染相关性最显著。绒毛膜羊膜炎的发生率在GBS、CT感染组中显著升高（列联系数r分别为0.375和0.277）,新生儿肺炎的发生率在GBS、CT、BV感染组中显著升高（列联系数r分别为0.248、0.239和0.245）,新生儿病理性黄疸的发生率在UU及CT感染组中显著升高（列联系数r分别为0.489和0.292）。结论:对GDM患者进行阴道微生物检测具有重要意义,尤其是GBS的感染可能会导致PPROM的发生,并进一步导致不良的妊娠结局,如绒毛膜羊膜炎及新生儿肺炎等。     

Randomized trial of antibiotics in addition to tocolytic therapy to treat preterm labor

Objective: The objective of this study was to assess whether antibiotic therapy plus tocolysis given to women in preterm labor would prolong pregnancy compared with tocolysis alone.Methods: A randomized, double-blind trial of intravenous mezlocillin and oral erythromycin therapy vs. placebo was used in addition to tocolysis among women in preterm labor 相似文献   

Targeted delivery at 34 versus 35 weeks in women with preterm prelabor rupture of membranes

Objective: To compare planned delivery at 34 versus 35 weeks for women with preterm prelabor rupture of membranes (PPROM).

Materials and methods: We performed a retrospective cohort study of singleton pregnancies with PPROM after 24 weeks delivered from 2006 to 2014. In 2009, an institutional practice change established 35 weeks as the target gestational age before induction of labor was initiated after PPROM. Demographic and outcome measures were compared for two cohorts: women delivered 2006–2008 – target 34 weeks (T34) and women delivered 2009–2014 – target 35 weeks (T35). The primary outcome was neonatal intensive care unit (NICU) admission.

Results: Of the 382 women with PPROM, 153 (40%) comprized the T34 cohort and 229 (60%) comprized the T35 cohort. Demographic characteristics were similar between groups. There were no differences between groups in gestational age at PPROM (31.0?±?3.3 weeks versus 31.2?±?3.1 weeks; p?=?.50) or maternal complications. The mean gestational age at delivery was earlier in the T34 group (31.8?±?3.2 weeks versus 32.4?±?2.7 weeks; p?=?.04). The median predelivery maternal length of stay (LOS) was 1?day longer in the T35 group (p?=?.03); the total and postpartum LOS were similar between groups (p?>?.05). There were no differences in the rate of NICU admission (T34 89.5% versus T35 92.1%; p?=?.38) or median neonatal LOS (T34 14 days versus T35 17 days; p?=?.15). In those patients who reached their target gestational age, both maternal predelivery LOS and total LOS were longer in the T35 group (p?>?.05). The frequency of NICU admission in those reaching their target gestational age was similar between groups (T34 83.37% versus T35 76.19%; p?=?.46).

Conclusions: A 35-week target for delivery timing for women with PPROM does not decrease NICU admissions or neonatal LOS. This institutional change increased maternal predelivery LOS, but did not increase maternal or neonatal complications.