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1.
目的:探讨胎膜早破的临床特点及与难产,妊娠结局间的关系。方法:回顾性分析我院2010年10月至2011年6月76例分娩发生胎膜早破的产妇的临床资料,选取同期未发生胎膜早破的76例产妇为对照,观察产妇胎膜早破原因,发生难产的情况以及妊娠结局情况。结果:胎膜早破组难产27例(35.53%),早产17例(22.36%),产褥感染4例(5.26%),新生儿窒息5例(6.58%),新生儿肺炎4例(5.26%),与对照组相比差异具有统计学意义(P<0.05)。结论:胎膜早破可以导致产妇难产率增加,危害母婴健康,必须采取有效措施控制感染,减少母婴并发症的发生。  相似文献   

2.
目的:探讨20年间双胎妊娠发生率及双胎妊娠并发症变化趋势,分析双胎妊娠的结局。方法:回顾分析1991年(24例)、2001年(87例)及2011年(287例)双胎妊娠分娩孕妇的临床资料。随机选取同年分娩的单胎妊娠孕妇各300例、900例及2900例作为对照组。分析双胎妊娠和单胎妊娠分娩孕妇的差异。结果:双胎妊娠率逐年增长。双胎妊娠孕妇主要以剖宫产方式终止妊娠。双胎妊娠的新生儿窒息、围生儿死亡率、低体重儿及新生儿转科率均显著高于单胎妊娠(P0.05)。与单胎妊娠相比,双胎妊娠的胎膜早破、早产、子痫前期、产后出血、贫血发生率显著增高(P0.05)。与1991年、2001年相比,2011年双胎妊娠合并贫血的发生率明显提高,子痫前期(PE)的发生率降低,差异显著(P0.05)。结论:双胎妊娠增加了妊娠期并发症及新生儿不良预后的发生。  相似文献   

3.
目的:探讨高龄经产妇不同妊娠间隔时间与妊娠结局(妊娠合并症、分娩并发症、新生儿窒息)的关系。方法:收集2019年1月至2020年6月在赣州市人民医院进行产前检查的高龄经产妇(其预产期年龄≥35岁) 205例作为研究对象。根据距上次妊娠间隔时间进行分组:A组(2~5年)97例、B组(6~9年) 63例、C组(≥10年) 45例。收集孕妇妊娠合并症、分娩方式、产程长短、分娩并发症、新生儿转科率及Apgar评分。比较各组妊娠结局的差异,以A组为对照,二分类Logistic回归分析评价妊娠间隔时间长短发生不同妊娠结局的风险。ROC曲线评估妊娠间隔时间预测发生不同妊娠结局的敏感性。结果:(1)A组、B组、C组经产妇的妊娠合并症、分娩并发症、第一产程时间、新生儿转科率和新生儿窒息程度整体上存在显著差异,A组不良妊娠结局的发生率最低,随妊娠间隔时间的延长,不良妊娠结局的发生率逐渐升高。(2)以A组作为参照,B组和C组发生妊娠期高血压、妊娠期糖尿病、胎膜早破、胎盘早剥、产后出血、羊水污染、新生儿窒息等结局的风险明显增加(P <0.05);加入年龄去除混杂因素后,与A组相比,B组发生胎膜早破(OR 2.35,95%CI 1.83~5.25,P=0.021)、胎盘早剥(OR 6.77,95%CI 3.46~12.73,P=0.000)的风险明显增加,C组发生妊娠期糖尿病(OR 3.86,95%CI 1.33~7.36,P=0.001)、胎膜早破(OR=6.92,95%CI 3.47~11.56,P=0.000),胎盘早剥(OR 12.88,95%CI 4.67~18.28,P=0.000)和新生儿窒息(OR4.82,95%CI 1.37~6.59、P=0.012)的风险显著增加。(3)ROC曲线表明,不同妊娠间隔时间预测发生妊娠期糖尿病、胎膜早破、胎盘早剥、新生儿窒息的敏感度分别为AUC=0.708,95%CI0.677~0.803; AUC=0.651,95%CI 0.556~0.683; AUC=0.606,95%CI 0.521~0.647; AUC=0.721,95%CI 0.681~0.788。结论:高龄孕妇发生不良妊娠结局的风险随着妊娠间隔时间的延长而逐渐增高。长妊娠间隔(6~9年、≥10年)是发生妊娠期糖尿病、胎膜早破、胎盘早剥、新生儿窒息的独立危险因素。  相似文献   

4.
目的:探讨不同年龄段高龄初产孕妇妊娠分娩结局。方法:回顾分析西北妇女儿童医院2016年1月1日至2020年1月1日分娩的2272例高龄初产妇的临床资料,其中高龄组(35~39岁)2040例,超高龄组(≥40岁)232例。比较孕产妇年龄与妊娠结局及围产儿结局的关系。结果:高龄组及超高龄组的剖宫产率分别为62.84%及88.79%,新生儿转ICU率分别为4.46%及7.76%,产后出血率分别为1.76%及3.02%。高龄组和超高龄组的剖宫产率、新生儿转ICU、胎膜早破比较,差异均有统计学意义(P均<0.05)。两组的低出生体重儿、巨大儿、早产、死产、低Apgar评分、新生儿发育异常、产后出血方面比较,差异均无统计学意义。高龄组、超高龄组剖宫产指征中“孕妇要求的剖宫产”占比均最高,分别为39.70%和79.38%。结论:高龄初产孕妇中,剖宫产率随着年龄增加,“孕产妇要求的剖宫产”占比增加明显,在围产儿及孕产妇并发症方面,除新生儿转ICU有所增加,严重并发症并不增加。  相似文献   

5.
目的:探讨胎膜早破的临床特点及与难产,妊娠结局间的关系。方法:回顾性分析我院2010年10月至2011年6月76例分娩发生胎膜早破的产妇的临床资料,选取同期未发生胎膜早破的76例产妇为对照,观察产妇胎膜早破原因,发生难产的情况以及妊娠结局情况。结果:胎膜早破组难产27例(35.53%),早产17例(22.36%),产褥感染4例(5.26%),新生儿窒息5例(6.58%),新生儿肺炎4例(5.26%),与对照组相比差异具有统计学意义(P〈0.05)。结论:胎膜早破可以导致产妇难产率增加,危害母婴健康,必须采取有效措施控制感染,减少母婴并发症的发生。  相似文献   

6.
目的:妊娠期妇女预防性应用抗氧化剂(维生素C,维生素E和丹参),了解抗氧化剂对产科并发症、分娩情况和围生儿情况的影响。方法:将2005年4月—2006年7月全国24家医院3 485例妊娠妇女前瞻性随机分为抗氧化剂组[应用维生素和(或)丹参者,1 607例]与对照组(未用任何药物者,1 878例),序贯性监测其产科并发症、分娩情况及新生儿情况。结果:①2组产科并发症比较,抗氧化剂组胎膜异常、胎儿宫内窘迫和羊水异常的发生率均低于对照组(P <0.01),但2组间妊娠期糖尿病(GDM)、妊娠期高血压(PIH)和妊娠合并肝内胆汁淤积(ICP)发生率的差异无统计学意义(P >0.05)。②抗氧化剂组平均妊娠周为39.17周,平均新生儿体质量为3 388.29 g,对照组平均分娩时间为39.08周,新生儿体质量为3 374.81 g,2组间差异均无统计学意义(P >0.05)。2组间早产、低体质量儿及巨大儿的发生率差异均无统计学意义(P >0.05)。③抗氧化剂组孕产妇病死率为0,围生儿病死率为0.44%,对照组分别为0.11%和0.11%,2组间差异无统计学意义(P >0.05)。④抗氧化剂组的新生儿疾病发病率明显低于对照组(P <0.01),以新生儿黄疸最为显著。结论: 妊娠期应用抗氧化剂对分娩时间、新生儿体质量、早产、低体质量儿、巨大儿、孕产妇及围生儿病死率等无明显影响,而对预防部分产科并发症和新生儿疾病等方面有所帮助,尤其预防胎膜早破、新生儿黄疸等疾病的效果肯定。  相似文献   

7.
目的:分析女性生殖器官发育异常对妊娠和分娩结局的影响.方法:采用回顾性调查方法,选择我院2000~2007年住院的生殖器官发育异常合并妊娠的孕妇72例为生殖道畸形组,并随机选取同期正常分娩孕妇136例为对照组,分析比较两组孕妇的分娩方式、并发症及围生儿情况等.结果:生殖道畸形组胎位异常、剖宫产率及胎膜早破、早产率、产后出血等主要并发症和对照组相比,差异均有统计学意义(P<0.05);发育异常的子宫对围生儿的影响使胎儿窘迫、新生儿窒息、胎儿生长受限的发生率与对照组相比,差异有统计学意义(P<0.05).结论:生殖器官发育异常的孕妇产科并发症多,应重视产前检查,加强孕期管理,以减少孕产妇的并发症,提高围生儿的存活率.  相似文献   

8.
目的:分析足月胎膜早破与难产及母婴并发症的关系。方法选择2010年1月—2010年12月在我院住院分娩的300例胎膜早破的孕妇做为观察组,另随机抽取本院同期无胎膜早破的健康孕妇300例作为对照组。比较两组的分娩方式及母婴并发症。结果胎膜早破组的剖宫产率,早产率,新生儿窘迫率及新生儿肺炎发生率均显著高与对照组.(p<0.05)两组产褥病率差异无统计学意义(p>0.05)结论胎膜早破的早产率,剖宫产率胎儿窘迫率,新生儿肺炎发生率升高。应重视胎膜早破的预防及不同孕周胎膜早破的处理,减少母婴并发症。  相似文献   

9.
目的:探讨双胎妊娠早产临床特点及其危险因素。方法:回顾性分析2009年1月1日至2016年12月31日在广州医科大学附属第三医院分娩的2427例双胎妊娠临床资料,将分娩孕周为28~36~(+6)周的双胎妊娠孕产妇及其新生儿作为早产组(1741例),同期分娩孕周为37~40~(+6)周的双胎妊娠孕产妇及其新生儿作为对照组(686例),比较两组病例临床资料特点,分析导致双胎妊娠早产的危险因素。结果:2009~2016年双胎妊娠分娩量呈上升趋势,平均早产率为71.73%。双胎妊娠早产中自发性早产占47%,医源性早产占28%,胎膜早破占25%。早产组平均分娩年龄、体外受精-胚胎移植(IVF-ET)受孕比例、初产妇比例、规律产检比例均较对照组低,差异有统计学意义(P0.05);既往剖宫产次、当次分娩剖宫产率及子痫前期、胎膜早破、羊水过少、前置胎盘、胎盘植入/粘连、瘢痕子宫比例均较对照组高,差异有统计学意义(P0.05)。多因素Logistic回归分析结果显示,子痫前期、胎膜早破、羊水过少、前置胎盘及不规律产检是双胎妊娠早产的危险因素(P0.05)。结论:双胎妊娠早产原因以自发性最多,其次为医源性及胎膜早破。子痫前期、胎膜早破、羊水过少、前置胎盘及不规律产检是双胎妊娠早产的独立危险因素。  相似文献   

10.
目的探讨子宫颈冷刀锥切术(cold-knife conization,CKC)对妊娠结局的影响。方法回顾性分析2006年1月至2009年6月因子宫颈上皮内瘤变III级(cervical intraepithelial neoplasiaⅢ,CINⅢ)行冷刀锥切术的41例(锥切组)患者的妊娠结局,并将其与同期无宫颈病变治疗史妊娠分娩的4 446例孕妇(对照组)进行比较。结果 41例患者中,3~6个月内妊娠者5例,6~12个月妊娠者17例,12~24个月妊娠者14例,2年后妊娠者5例。7例孕早期行人工流产,2例孕早期自然流产,1例晚期流产,31例成功分娩(75.61%),其中5例(16.13%)早产,26例(83.87%)足月分娩;阴道分娩23例,无宫颈性难产,剖宫产8例。与对照组比较,锥切组的妊娠时限短于对照组(P0.001);锥切组早产率高于对照组[8.57%(381/4 446)](P0.01);锥切组胎膜早破率[19.35%(6/31)]高于对照组[7.11%(316/4 446)](P0.01);锥切组早产胎膜早破[9.68%(3/31)]高于对照组[1.17%(52/4 446)](P0.001);新生儿出生体重2 511~4 050 g,无新生儿窒息。两组新生儿出生体重比较,差异无统计学意义(P0.05);宫颈裂伤和分娩方式比较,差异无统计学意义(P0.05)。结论宫颈冷刀锥切术是孕中期流产、早产和早产胎膜早破的高危因素,不增加宫颈裂伤的发生率,不影响分娩方式。  相似文献   

11.
Summary. The influence of the time interval from rupture of the membranes to delivery on neonatal respiratory adaptation was analysed in a prospective study of all infants born in Goteborg, Sweden in one year. The correlation between the incidence of respiratory disorders and the rupture-delivery interval was analysed in all preterm infants (≤36 weeks, n =240) and in all term infants born by caesarean section ( n =452). A uniform pattern was found for all preterm infants, irrespective of mode of delivery, and for the term infants born by caesarean section. The curve was 'U-shapeď with higher incidence of respiratory diseases in infants born immediately after rupture of the membranes than in those born 3–36 h after membrane. rupture. The incidence increased again in infants born >36 h after membrane rupture. The same pattern was found for all kinds of respiratory diseases including idiopatic respiratory distress syndrome. Therefore, there seems to be no advantage in postponing delivery 36h after rupture of the membranes.  相似文献   

12.
Summary. The influence of the time interval from rupture of the membranes to delivery on neonatal respiratory adaptation was analysed in a prospective study of all infants born in Goteborg, Sweden in one year. The correlation between the incidence of respiratory disorders and the rupture-delivery interval was analysed in all preterm infants (≤36 weeks, n =240) and in all term infants born by caesarean section ( n =452). A uniform pattern was found for all preterm infants, irrespective of mode of delivery, and for the term infants born by caesarean section. The curve was 'U-shape' with higher incidence of respiratory diseases in infants born immediately after rupture of the membranes than in those born 3–36 h after membrane. rupture. The incidence increased again in infants born >36 h after membrane rupture. The same pattern was found for all kinds of respiratory diseases including idiopatic respiratory distress syndrome. Therefore, there seems to be no advantage in postponing delivery >36h after rupture of the membranes.  相似文献   

13.
The influence of the time interval from rupture of the membranes to delivery on neonatal respiratory adaptation was analysed in a prospective study of all infants born in G?teborg, Sweden in one year. The correlation between the incidence of respiratory disorders and the rupture-delivery interval was analysed in all preterm infants (less than or equal to 36 weeks, n = 240) and in all term infants born by caesarean section (n = 452). A uniform pattern was found for all preterm infants, irrespective of mode of delivery, and for the term infants born by caesarean section. The curve was 'U-shaped' with higher incidence of respiratory diseases in infants born immediately after rupture of the membranes than in those born 3-36 h after membrane rupture. The incidence increased again in infants born greater than 36 h after membrane rupture. The same pattern was found for all kinds of respiratory diseases including idiopathic respiratory distress syndrome. Therefore, there seems to be no advantage in postponing delivery greater than 36 h after rupture of the membranes.  相似文献   

14.
The incidence of multiple pregnancies increases with concomitant increased risk in maternal and fetal complications. Delayed delivery is still a rare occurrence in the literature despite advances in reproductive medicine and increasing number of multiple gestations. Authors report a case of delayed delivery in a dichorionic, diamniotic twin pregnancy. A 28-year-old woman delivered her first twin in the 25th week of gestation, 4 weeks after the preterm rupture of membranes. The newborn died on the first day of life due to prematurity. Cervical cerclage was performed, patient received antibiotics, corticosteroids and tocolytics. The second twin was successfully delivered by cesarean section in the 28th week of pregnancy, 18 days after the first twin was born. The baby was discharged home in good condition on the 64th day after the delivery. The conclusion was, that using tocolysis, antenatal steroids to stimulate lung maturation, antibiotics and cervical cerclage after delivery of the first fetus we can improve the life-expectancy of the retained fetus. Delayed delivery is a reasonable option for patients with multifetal pregnancies and premature delivery of the first baby or preterm rupture of membranes in the second trimester.  相似文献   

15.
OBJECTIVE: To examine the relationship between vaginal bleeding during early pregnancy and preterm delivery. METHODS: Study subjects (N=2678) provided information regarding socio-demographic, biomedical, and lifestyle characteristics. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: Any vaginal bleeding in early pregnancy was associated with a 1.57-fold increased risk of preterm delivery (95% CI: 1.16-2.11). Vaginal bleeding was most strongly related with spontaneous preterm labor (OR=2.10) and weakly associated with preterm premature rupture of membrane (OR=1.36) and medically induced preterm delivery (OR=1.32). As compared to women with no bleeding, those who bled during the first and second trimesters had a 6.24-fold increased risk of spontaneous preterm labor; and 2-3-fold increased risk of medically induced preterm delivery and preterm premature rupture of membrane, respectively. CONCLUSION: Vaginal bleeding, particularly bleeding that persists across the first two trimesters, is associated with an increased risk of preterm delivery.  相似文献   

16.
OBJECTIVE: To evaluate whether intraventricular hemorrhage and periventricular leukomalacia are characterized by different risk factors. METHODS: In a cohort of 653 consecutive singleton neonates born after preterm membrane rupture, spontaneous preterm labor, or indicated preterm delivery at 24 to 33 weeks of gestation from January 1, 1993, to December 31, 2002, we evaluated the obstetric and histopathologic placental variables in reference to the development of intraventricular hemorrhage (n = 44), periventricular leukomalacia (n = 19), or no ultrasonographic cerebral lesion (n = 589). Excluded were stillbirths and congenital anomalies. Statistical analysis included Fisher exact test, Student t test, and stepwise logistic regression analysis with a 2-tailed P <.05 considered significant. RESULTS: Multivariate analysis showed that occurrence of neonatal intraventricular hemorrhage and periventricular leukomalacia were associated only with spontaneous prematurity (odds ratio = 1.9; 95% confidence interval 1.1-3.4) and gestational age at delivery in weeks (odds ratio = 0.8; 95% confidence interval 0.7-0.9). Neonates with intraventricular hemorrhage did not differ from those with periventricular leukomalacia in any obstetric or neonatal variable, but there was a higher risk of neurodevelopmental delay associated with periventricular leukomalacia. CONCLUSION: Among premature infants born at less than 34.0 weeks of gestation, intraventricular hemorrhage and periventricular leukomalacia share common clinical characteristics, with spontaneous preterm delivery and gestational age at delivery as the only independent antenatal predictors.  相似文献   

17.
OBJECTIVE: The purpose of this study was to ascertain the predictive value of antecedent preterm premature rupture of membranes for recurrent preterm premature rupture of membranes and preterm delivery rates in the next pregnancy compared with background rates among a population-based sample of women at a single institution. STUDY DESIGN: Records of patients with index singleton pregnancies that were complicated by preterm premature rupture of membranes whose next delivery resulted in a delivery at >or=20 weeks at the same institution were reviewed for the incidence and gestational age of recurrent preterm premature rupture of membranes and preterm delivery. All subjects were patients of physicians whose obstetric practices were based at a single institution. Background rates of preterm premature rupture of membranes and preterm delivery in this population were generated from a systematically selected comparison group composed of the two deliveries after each of the study group's second delivery. RESULTS: The rates of recurrent preterm premature rupture of membranes (16.7%) and preterm delivery (34.2%) in the 114 study group patients were substantially greater (odds ratio, 20.6; 95% CI, 4.7-90.2; and odds ratio, 3.6; 95% CI, 2.1-6.4) than noted background rates (0.96% and 12.5%) but considerably less than the recurrence rates of either preterm premature rupture of membranes or preterm delivery that were reported by others. The gestational age of preterm premature rupture of membranes in the index pregnancy affected neither the magnitude of risk nor the gestational age of recurrent preterm premature rupture of membranes or preterm delivery in the subsequent pregnancy. Stratification of outcome measures into three subgroups that were based on the gestational age of index preterm premature rupture of membranes demonstrated no significant differences in the incidence of preterm premature rupture of membranes or preterm delivery. CONCLUSION: After a pregnancy that was complicated by preterm premature rupture of membranes, the risk for recurrent preterm premature rupture of membranes is increased by 20-fold and for recurrent preterm delivery by almost 4-fold. Gestational age of antecedent preterm premature rupture of membranes is predictive of neither risk nor timing of recurrent complications. Estimates of recurrence risks appear to be moderated by limiting analysis to a population-based sample of gravid women when compared with previous studies.  相似文献   

18.
OBJECTIVE: To examine the association between prepregnancy body mass index (BMI) and neonatal mortality while accounting for the timing of delivery and subtypes of preterm birth. METHODS: The study population included 85,375 liveborn singletons of mothers in the Danish National Birth Cohort (1996-2002) who were interviewed during the second trimester. Information about pregnancy outcomes and neonatal deaths (n=230) was obtained from national registers. The association was estimated by Cox regression analyses and results were presented as hazard ratios with 95% confidence intervals (CIs). RESULTS: Compared with infants of mothers who were at a normal weight before pregnancy (BMI of 18.5 or more but less than 25), neonatal mortality was increased in infants of mothers who were overweight (BMI of 25 or more but less than 30) or obese (BMI of 30 or more) (adjusted hazard ratios 1.7, CI 1.2-2.5, and 1.6, CI 1.0-2.4, respectively). For preterm infants (n=3,934, 136 deaths), neonatal mortality in infants born after preterm premature rupture of membranes (PROM) was significantly increased if they were born to an overweight or obese mother (adjusted hazard ratios 3.5, CI 1.4-8.7, and 5.7, CI 2.2-14.8). There were no associations between high BMI and neonatal mortality in infants born after spontaneous preterm birth without preterm PROM or in infants born after induced preterm delivery. CONCLUSION: High maternal weight seems to increase the risk of neonatal mortality, especially in infants born after preterm PROM. Inflammation or infection related to obesity may be part of the causal pathway. LEVEL OF EVIDENCE: II.  相似文献   

19.
OBJECTIVE: The purpose of this study was to investigate the use of fetal lung length estimation by ultrasound in the prediction of adverse neonatal respiratory outcome after prolonged preterm rupture of the membranes. METHODS: From the hospital database of all cases of spontaneous membrane rupture /=7 days after membrane rupture needed to be available and the last lung length prior to delivery was used to predict adverse respiratory outcome. Complete neonatal follow-up was available on all babies. Neonatal outcome measures included survival, bronchopulmonary dysplasia defined as an oxygen requirement at 36 weeks' gestation, and neonatal respiratory death in non-survivors. Two groups, good and poor outcomes, were defined. A comparison of the last lung length before delivery (corrected for gestation) between the good and poor outcome groups was made to determine whether lung length could predict neonatal outcome. RESULTS: There were 43 live births. All had received antenatal corticosteroids as part of the management of prematurity. There were no differences in maternal age, ethnicity, parity and the incidence of antepartum haemorrhage between the good and poor outcome groups. Parameters significantly associated with good outcome included gestation at membrane rupture, large pool of amniotic fluid and gestation at delivery. The last fetal lung length did not predict adverse neonatal respiratory outcome. In the 28 babies where membrane rupture was >/=21 days the findings were the same. CONCLUSION: Fetal lung length determined by antenatal ultrasound does not predict adverse neonatal respiratory outcome and the prediction of pulmonary hypoplasia in live borns after prolonged preterm rupture of the membranes remains an elusive goal.  相似文献   

20.
胎膜早破致早产266例临床分析   总被引:4,自引:0,他引:4  
目的探讨早产性胎膜早破的临床处理及母儿结局。方法回顾分析。1993年1月~2002年12月因胎膜早破而早产的266例孕妇,对部分孕妇的宫颈分泌物进行培养并对感染性病因分组比较,采用SAS软件进行计算机统计分析。结果感染为导致胎膜早破的主要原因之一,且与胎膜早破及宫内感染密切相关(P<0.05)。联合应用抗生素及宫缩抑制剂等适当保胎治疗可延长孕周,保胎组与无保胎组间宫内感染及剖宫产率的差异有显著性(P<0.05),<35孕周的孕妇促胎肺成熟的差异有显著性(P<0.05),围生儿死亡的差异有显著性(P<0.05)。结论早产性胎膜早破的主要病因是感染,应用抗生素及糖皮质激素可改善母儿预后。  相似文献   

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