未足月胎膜早破的宫缩抑制剂治疗

胎膜早破的病因主要有:生殖道感染、羊膜腔内压力增高、羊水过多、胎位异常、宫颈内口松弛及胎膜发育异常等。胎膜早破可导致孕妇感染和胎盘早剥,以及胎儿早产、感染、脐带脱垂等并发症。临床上用宫缩抑制剂治疗未足月胎膜早破(PPROM)以延长孕周提高围产儿存活率,因治疗同时也有发生宫内感染、胎儿宫内窘迫等,宫缩抑制剂的使用还存在有不同看法。     

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。     

妊娠晚期羊水过少与围产儿结局的临床分析

目的 探讨羊水过少与围产儿不良结局的关系，寻找处理羊水过少的正确方法，降低围产儿的病死率。方法 对羊水过少的84例临床资料进行回顾性分析。结果 羊水过少患者的羊水粪染率、胎儿窘迫率、新生儿窒息率、剖宫产率均明显高于羊水正常组。结论 羊水过少是引起围产儿不良结局的重要原因。     

英国皇家妇产科医师学会《脐带脱垂指南》2014版要点解读

脐带脱垂是在胎膜破裂情况下,脐带脱至子宫颈外,位于胎先露一侧（隐性脐带脱垂）或越过胎先露（显性脐带脱垂）,是导致围产儿死亡的重要原因,发生率为0.1%～0.6%。导致脐带脱垂的主要原因包括胎位不正、多次分娩、胎膜早破、羊水过多、产科干预等因素,其导致的胎儿不良结局包括早产、新生儿窒息甚至新生儿死亡。     

特发性轻度羊水过多与围产儿结局的关系

羊水过多与围产儿不良结局的关系已较明确,而孕末期经超声波发现的无原因轻度羊水过多与围产儿结局的关系则报道很少。为揭示特发性轻度羊水过多与围产儿预后的关系,对1177例孕26周以后胎儿进行生物物理像监测。在除外发现羊水过多前孕妇即有症状(宫缩或呼吸困难)者和合并有糖尿病、Rh 血型不合、胎儿畸形、胎儿染色体畸形及多胎妊娠者后,每周进行一次胎儿生物物理像监测及羊水指数的测定。正常羊水指数为8. 1～24. 0,     

羊水过少100例临床分析

羊水过少１００例临床分析门小云羊水过少是引起围产儿不良结局的重要原因之一，随着围产医学的进展，对足月、超期及过期妊娠的羊水过少的诊断、处理、分娩方式等的研究越来越受到产科工作者的重视。现将我院１９９０年１月至１９９２年２月收治的羊水过少１００例，随机...     

胎儿心律失常的诊断和治疗

胎儿心电监护及胎儿超声心动图是发现胎心律异常的主要检查手段。频发严重的胎心律异常,尤其伴心脏畸形或心脏器质性病变的胎心律异常可导致不良围产儿结局。早期诊断、及时治疗严重的胎心律异常可明显改善围产儿预后,减少围产儿不良结局的发生。     

孕28～36周胎膜早破孕妇保守治疗92例分析

孕２８～３６周胎膜早破孕妇保守治疗９２例分析虞荷莲金敏菲未足月胎膜早破（ＰｒｅｔｅｒｍＰｒｅｍａｔｕｒｅＲｕｐｔｕｒｅｏｆＭｅｍｂｒａｎｅｓＰＰＲＯＭ）的处理是产科的棘手问题，其围产儿病率和死亡率相当高，引起产科关注。本文对９２例孕２８～３６周胎膜早...     

未足月胎膜早破的研究进展

未足月胎膜早破(preterm premature rupture of the membranes，PPROM)是指妊娠未满37周胎膜在临产前发生破裂。在所有妊娠中PPROM发生率为1％～2％，早产合并PPROM占30％。PPROM孕妇中只有7．7％～9．7％的胎膜破口能够自然愈合，而持续阴道流液的孕妇，60％在7d内启动分娩。由于羊膜腔处于与外界相通的状态和羊水持续渗漏，PPROM不仅可导致羊水过少，羊膜腔内感染；还可能引起早产，围产儿病死率显著增加。因此，及早诊断和有效治疗PPROM极其重要。     

妊娠晚期羊水过少分娩方式的探讨

羊水过少是指妊娠晚期羊水量＜300ml,是一种需要高度警惕的妊娠并发症.妊娠晚期、尤其在分娩过程中羊水过少胎儿与脐带容易受压,缺血缺氧,导致胎儿窘迫,胎死宫内,新牛儿窜息.根据孕妇的具体情况,选择适当的分娩方式以降低围产儿病率及死亡率十分重要.现对我院2000～2008年109例羊水过少病例的分娩方式与妊娠结局进行分析,其中不含胎膜早破所致羊水过少病例.     

Impact of preterm PROM and its complications on long-term infant outcomes

There is increasing evidence that preterm premature rupture of membranes (PPROM) is associated with increased risk for adverse neurodevelopmental outcomes through multiple mechanisms, including preterm birth and its antecedent etiologies. Intrauterine infection is a particularly important risk factor for adverse neurodevelopmental outcomes after PPROM. This review focuses on the long-term neurodevelopmental outcomes after PPROM, the possible etiologic mechanisms of neurological injury, and the effect of antenatal and perinatal interventions using available evidence.     

Placental histologic patterns and neonatal seizure,in preterm premature rupture of membrane

Objective: To investigate the relationship between placenta and perinatal outcomes, in preterm infants born to mothers with preterm premature rupture of fetal membrane (PPROM).

Methods: We report detailed histology of placentas and perinatal outcomes of infants from 79 PPROM pregnancies. Placental histologic pattern and adverse perinatal outcomes were assessed by logistic regression, adjusting for gestational age at birth, birth weight and interval from rupture of membrane to delivery.

Results: Mean gestational age at membrane rupture was 29.5?±?3.4 weeks. The incidence of histologic chorioamnionitis (HCA), fetal inflammatory response (FIR) and vascular thrombotic abnormalities in placental histologic examination were 63.3, 25.3 and 78.5%, respectively. Neonates with FIR showed significantly higher incidence of periventricular leukomalacia (PVL) (85% versus 59.3%, p?=?0.0364) at brain ultrasonography, than neonates without FIR, in univariate analysis, but not in logistic regression analysis. In logistic regression analysis, the odds ratio of low Apgar score at 1?min in the neonates with clinical chorioamnionitis was 5.009 (95% CI, 1.242–20.195). The odds ratio of neonatal seizure in the neonates with FIR and vascular thrombotic problem was 7.486 (95% CI, 1.617–34.653).

Conclusions: Our findings support the association between FIR with vascular thrombotic problem in placenta and neonatal seizure, in pregnancies with PPROM.     

孕产妇血清中MMP-3、TNF-α、IL-10的表达与早产和早产胎膜早破的关系

目的探讨基质金属蛋白酶-3（MMP-3）、肿瘤坏死因子-α（TNF-α）、白细胞介素-10（lL-10）在孕产妇血清中的表达与早产、胎膜早破的关系。方法选择单胎头位初产妇80例作为研究对象,按孕周、胎膜是否破裂和产妇是否临产分为早产临产组（sPTD）、早产胎膜早破组（PPROM）、先兆早产组（TPL）和妊娠28～36＋6周无产兆组（对照组）,每组各20例。用ELISA法检测孕妇血清中MMP-3及TNF-α、lL-10的水平。结果①早产临产组、早产胎膜早破组、先兆早产组和对照组血清中MMP-3的浓度分别为（242.25±72.40）ng/ml、（225.95±85.43）ng/ml、（197.85±57.08）ng/ml、（186.80±54.33）ng/ml;TNF-α的浓度分别为（1332.35±346.65）pg/ml、（1365.00±211.80）pg/ml、（1188.15±269.43）pg/ml、（1061.85±210.02）pg/ml;IL-10的浓度分别为（563.65±116.50）pg/ml、（566.80±123.03）pg/ml、（521.00±105.14）pg/ml、（483.50±119.17）pg/ml;②早产组血清中MMP-3,TNF-α浓度高于对照组,以TNF-α升高更明显（P〈0.01）;而IL-10在前两组中有增高趋势,但与后两组相比差异无统计学意义（P〉0.05）;③血清中MMP-3、TNF-α、IL-10浓度呈两两正相关。结论①孕产妇血清中MMP-3及TNF-α浓度与早产、胎膜早破密切相关;②孕产妇血清中MMP-3、TNF-α及IL-10在临产、胎膜早破中可能起协同作用。     

Outcomes of preterm premature rupture of membranes in twin pregnancies

Objective. To describe outcomes in twin pregnancies with preterm premature rupture of membranes (PPROM).

Methods. Dichorionic twin pregnancies complicated by PPROM at <34 weeks of gestation for the period 2003 to 2006 were identified. Outcomes were obtained through chart review. The relationship between gestational age at premature rupture of membranes (PROM), latency from PROM to delivery, and infection were examined.

Results. In 49 twin pregnancies, the median gestational age at PROM was 31 weeks with a median latency between PROM and delivery of 0 days (interquartile range 0–6). Latency intervals of ≥2 and ≥7 days were achieved by 40.8% and 22.4%, respectively. PPROM at <30 weeks was associated with significantly higher rates of latency of ≥ 2 days (70.6% vs. 25.0%) and ≥7 days (47.1% vs. 9.4%). There was a significant relationship between latency and clinical and histologic signs of infection.

Conclusions. After 30 weeks, most twin pregnancies with PPROM delivered within 2 days. Infection appears to be a consequence rather than a cause of PPROM in most cases.     

Premature rupture of membranes before 28 weeks managed expectantly: maternal and perinatal outcomes in a developing country

This study aimed to assess outcomes of expectant management for early preterm premature rupture of membranes (PPROM). This retrospective cohort involved 66 women with PPROM <28 weeks managed in a single hospital (1999-2006). Main outcomes were chorioamnionitis, severe maternal morbidity (maternal sepsis, haemorrhage/blood transfusion, hysterectomy or admission to intensive care unit), maternal mortality, low birth weight, preterm birth, neonatal infection and perinatal mortality. Mean gestational ages at PPROM and delivery were 21.7 ± 4.2 and 28.4 ± 5.9 weeks, respectively. Chorioamnionitis was diagnosed in 47%; no cases of severe maternal morbidity or mortality occurred. Stillbirth rate was 25.7% and >80% of infants were delivered before 34 weeks. Neonatal infection was diagnosed in 42.9% of the 49 live-births. Overall survival rate was 57.6%. Expectant management of PPROM <28 weeks resulted in high rates of chorioamnionitis and preterm deliveries but in over half of the cases, a live infant was discharged home.     

Preterm premature rupture of the membranes and antioxidants: the free radical connection

AIM: To discuss the role of oxidant stress in preterm, premature rupture of the membranes (PPROM). RESULTS: There is evidence to suggest that preterm, premature rupture of the membranes occurs secondary to focal collagen damage in the fetal membranes. CONCLUSION: Oxidant stress caused by increased ROS formation and/or antioxidant depletion may disrupt collagen and cause premature membrane rupture. We propose that supplementation with vitamins C and E may synergistically protect the fetal membranes, and decrease the risks of PPROM.     

'Perinatal outcome in preterm premature rupture of membranes with Amniotic fluid index < 5 (AFI < 5)

Background  

Our purpose was to determine whether AFI<5 cm after preterm premature rupture of the membranes (PPROM) is associated with an increased risk of perinatal morbidity.     

Perinatal outcomes and duration of preterm premature rupture of membranes

DESIGN: 30% preterm deliveries are the consequence of preterm premature rupture of membranes. The available data suggests lack of benefit of conservative management of preterm premature rupture of membranes. OBJECTIVE: Our objective was to compare perinatal outcomes in regard to the duration of rupture of membranes and gestational ages. MATERIALS AND METHODS: 435 newborns delivered below 28 weeks of pregnancy, 28-32 weeks of pregnancy and above 32 weeks of pregnancy were studied. RESULTS: There was no significant difference in the group of newborns delivered before 33 weeks of gestation. CONCLUSION: The duration of rupture of membranes had significant on perinatal outcomes among neonates born after 33 weeks of gestation.