宫颈环扎术后胎膜早破患者宫颈环扎线拆除时机的选择

目的:探讨宫颈环扎术后发生胎膜早破宫颈环扎线拆除的最佳时机。方法:回顾性分析2000年5月~2008年5月8年间在该院住院行宫颈环扎术且于28~34周发生胎膜早破患者,分为宫颈环扎线早期拆线(24 h)和延期拆线(24h)两组,比较两组母婴围产结局,包括孕周延长时间,母体绒毛膜羊膜炎或内膜炎,新生儿出生体重,新生儿NICU住院时间,新生儿感染率及新生儿死亡率。结果:43例患者早期拆除宫颈环扎线,有55例患者延期拆除宫颈环扎线,平均拆除宫颈环扎线时间分别为(4.1±0.8)h和(210.8±9.2)h。抗生素应用、地塞米松促胎肺成熟率及应用宫缩抑制剂率两组间比较无统计学差异。延期拆线组可明显延长孕周时间(P0.01)。胎膜早破48 h内分娩率早期拆线组为44.2%,延期拆线组为5.5%,两组比较有统计学差异(P0.01)。胎膜早破7天内分娩率早期拆线组为74.4%,明显高于延期拆线组的40.0%。孕妇宫内感染率延期拆线组为43.6%,早期拆线组为20.9%。新生儿出生体重延期拆线组明显高于早期拆线组。新生儿败血症发生率两组间比较无统计学差异,新生儿发病率,死亡率,NICU住院时间比较无统计学差别。结论:延期拆除宫颈环扎线可明显延长孕周,增加孕妇宫内感染的机会,但是对围产儿结局无不良影响。

Management of cervical cerclage after preterm premature rupture of membranes

Objective:To evaluate immediate versus delayed removal of cervical cerclage for women with preterm premature rupture of membranes with respect to maternal and neonatal outcomes.Methods:The authors retrospectively analyzed women with preterm premature rupture of membranes at 28～34 weeks' gestation with prior cervical cerclage placement.Timing of cervical cerclage removal,immediate(<24 hours) or delayed(>24 hours),was compared.Results:There were 43 women in the immediate-removal group and 55 in the delayed-removal group.Average times to removal were(4.1±0.8)h and(210.8±9.2)h respectively.Use of betamethasone,antenatal antibiotic and short-term tocolytic were similar for both groups;Duration of latency was significantly longer with delayed removal((266.5±6.9) hours vs.(109.5±8.7) hours,P<0.01).Delivery occurred <48 hours from preterm premature rupture of membranes in 5.5% versus 44.2%,P<0.01.And >7 days from rupture in 60%(33/55) versus 21%(9/43),P=0.03.Birth weight was statistically different.Rates of neonatal sepsis(at <10 days) and maternal infection were not statistically different.Neonatal outcomes did not significantly differ regarding mortality,respiratory distress syndrome,or duration of stay in the intensive care nursery.Conclusion:With the current management scheme for preterm premature rupture of membranes,cerclage retention significantly increases duration of latency and rate of maternal infection but not significantly alters neonatal outcomes.