医源性早产71例临床分析

目的探讨医源性早产的影响因素和早产儿结局。方法回顾性分析1年中我院住院孕妇因各种原因在37周前终止妊娠71例，分析其衫响的高危因素，比较不同孕周终止妊娠对早产儿的影响。结果重度子痫前期和前置胎盘是引起医源性早产最常见的原因，随着孕周增加，尤其是33孕周以后，早产儿窒息、新生儿呼吸窘迫综合征（NRDS）发病率和早产儿患病率均明显下降。同时早产儿住院天数和住院费用也随孕周增加而减少。结论对不可避免的医源性早产，产前定期检查和适当干预，选择恰当孕周终止妊娠可取得良好的围产儿结局。     

先兆子癎致医源性早产122例分析

目的　探讨先兆子发生在妊娠小于 3 7周的母儿结局。　方法　回顾性分析我院19 93年 1月～ 2 0 0 2年 12月间收治的 12 2例 (多胎妊娠除外 )孕周小于 3 7周的先兆子孕妇的诊断、处理母儿结局。按终止妊娠的孕周将 12 2例孕妇分为三组 ,1组为妊娠 2 8周～ 3 1+ 6 周 (2 8例 ) ;2组为妊娠 3 2～ 3 3 + 6 周 (2 6例 ) ;3组为妊娠 3 4～ 3 6+ 6 周 (68例 ) ,比较其发病情况、疾病进展、母儿并发症及结局。采用SAS软件进行计算机统计分析。　结果　起病早的妊娠高血压综合征 ,在短期内就可发展为先兆子 (14 0 3d ,16 85d ,2 2 2 2d ,P <0 .0 5)。不同孕周的先兆子孕妇经控制病情及适时终止妊娠 ,各组孕妇的子 (3 57% ,3 85% ,4 41% )、胎盘早剥 (2 8 57% ,11 54% ,10 2 9% )、HELLP综合征 (14 2 9% ,3 85% ,11 76% )、肝肾损害及胎儿宫内窘迫 (17 86% ,3 0 76% ,3 9 71% )、FGR(2 5 0 0 % ,2 6 92 % ,2 7 94% )等严重并发症的发生无统计学意义 (P >0 .0 5) ,孕妇预后良好。在不增加孕妇并发症的同时延长孕周 ,使 60 .64%的孕妇接受了促胎肺成熟的治疗。三组不同孕周的围产儿的SGA、颅内出血、呼吸暂停发生的差异无显著性 (P >0 .0 5) ;尽管RDS(2 2 73 % ,8 0 0 % ,4 48% )及重度窒息 (3 6     

医源性早产

医源性早产是指有医学指征需要早产分娩者。近年呈上升趋势，渐成早产不容忽视的原因之一。其发生率因地区和技术水平而不同。导致医源性早产的原因主要是慢性高血压、子痫前期、胎儿生长受限和多胎妊娠等。医源性早产主要发生于妊娠28～34周。对于妊娠26周前的医源性早产倾向于经阴道诱导分娩，妊娠26-34周选择性剖宫产成为主流，妊娠34周以后两种分娩方式均可以考虑。医源性早产对改善妊娠妇女并发症发病以及新生儿结局方面的作用有待大样本前瞻性研究的进一步证实。     

医源性早产1823例临床分析

目的:研究医源性早产的发生率、发生因素以及分娩方式。方法:回顾性分析了2004年1月至2009年12月四川大学华西第二医院发生的医源性早产1823例。结果:2004年1月至2009年12月,四川大学华西第二医院医源性早产发生率为6.84%,占早产总例数的50.30%。妊娠期肝内胆汁淤积症(ICP)、产前出血、妊娠期高血压疾病是导致医源性早产的前3位因素,分别占医源性早产总数的26.77%、23.64%、19.53%。118例医源性早产由人为因素造成。剖宫产终止妊娠1598例(87.66%)。结论:医源性早产已逐步成为早产的主要原因,人为因素已成为医源性早产的一大原因,剖宫产是医源性早产终止妊娠主要方式,产科医师应严格选择医源性早产终止妊娠的方式。     

医源性早产

医源性早产是指有医学指征需要早产分娩者.近年呈上升趋势,渐成早产不容忽视的原因之一.其发生率因地区和技术水平而不同.导致医源性早产的原因主要是慢性高血压、子痫前期、胎儿生长受限和多胎妊娠等.医源性早产主要发生于妊娠28～34周.对于妊娠26周前的医源性早产倾向于经阴道诱导分娩,妊娠26～34周选择性剖宫产成为主流,妊娠34周以后两种分娩方式均可以考虑.医源性早产对改善妊娠妇女并发症发病以及新生儿结局方面的作用有待大样本前瞻性研究的进一步证实.     

胎膜早破合并早产110例妊娠结局分析

胎膜早破为产科常见并发症 ,而妊娠不足月的产妇发生胎膜破裂后常合并早产 ,这种情况的出现使临床处理较为复杂。本文对 110例不足月的胎膜早破合并早产进行回顾性分析 ,就其相关问题进行讨论。1　资料与方法1 1　一般资料　 1998年 1月至 2 0 0 1年 10月在我院住院分娩共 340 3例 ,同期胎膜早破 372例 ,而妊娠 2 8～ 36周 6胎膜早破者 110例。不足月胎膜早破占同期住院分娩总数的 3 2 % ,占整个胎膜早破的 2 9 6 %。该组病例平均妊娠周数 34 3周 ,平均年龄 2 7 5岁。其中初产妇 10 0例 ,经产妇 10例。单胎 10 1例 ,双胎 9例 ,胎死宫内 2…     

早产合并胎膜早破108例分析

早产和胎膜早破经常同时存在 ,但胎膜早破使早产的处理变得复杂化 ,且早产并胎膜早破的围生儿病率和病死率相当高。所以恰当处理早产合并胎膜早破 (ｐｒｅｍａｔｕｒｅｌａｂｏｒｃｏｍｐｌｉｃａｔｅｄｗｉｔｈｐｒｅｍａｔｕｒｅｒｕｐｔｕｒｅｏｆｍｅｍｂｒａｎｅ,ＰＰＲＯＭ )将是减少围生儿死亡的关键。本文将我院 1996 1999年内早产并胎膜早破病例 10 8例诊治情况总结报道如下。1　临床资料早产合并胎膜早破是指孕满 2 8周而不满 37周 ,胎膜在临产前自然破裂的病例。收集我院 1996年 1月至 1999年 12月住院分娩的早产并胎膜早破病例 …     

早产胎膜早破95例妊娠结局的临床分析

目的:探讨早产胎膜早破(PPROM)的相关构成因素及不同孕周的妊娠结局。方法:选取我院2013年10月至2016年7月期间收治的95例PPROM的孕妇作为研究对象,分为观察组(孕周2833~(+6)周)和对照组(孕周3436~(+6)周),分析其相关构成因素、分娩方式及妊娠结局。结果:生殖道感染是PPROM的最主要构成因素,占33.68%。观察组的剖宫产率、新生儿窒息率、新生儿感染率及新生儿死亡率均显著高于对照组,差异均有统计学意义(P0.05)。观察组宫内感染率及产褥期感染率高于对照组,但差异无统计学意义(P0.05)。结论:生殖道感染是PPROM最主要的构成因素,对妊娠不足34周的PPROM患者采取积极保胎治疗及预防感染措施,以延长其孕周降低新生儿并发症的发生率,改善妊娠结局。     

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。     

双胎妊娠早产危险因素的临床分析

目的:探讨双胎妊娠早产的发生情况及可能的危险因素。方法:回顾性分析2016年1~12月于首都医科大学附属北京妇产医院分娩的343例双胎妊娠病例的临床资料,其中早产组170例,足月产组173例,分析引起双胎妊娠早产的可能影响因素。结果:早产组平均分娩孕周、剖宫产率、第一胎头先露比例、两胎儿平均出生体质量、1分钟及5分钟Apgar评分显著低于足月产组,而单绒毛膜性比例及新生儿窒息比例显著高于足月产组,差异有统计学意义(P0.05)。Logistic回归分析显示,单绒毛膜性、胎膜早破、妊娠期高血压疾病(HDCP)及瘢痕子宫是双胎妊娠早产的危险因素(P0.05)。结论:早产与胎儿绒毛膜性、胎膜早破、HDCP及瘢痕子宫等多种因素密切相关,对合并高危因素的双胎妊娠需要高度重视,在加强孕期监护同时,应依据风险因素制定个体化干预措施,以确保母婴安全、减少新生儿窒息与死亡。     

Difficulties in establishing routine amniocentesis for preterm labor evaluation

After a recent practice change implementing amniocentesis into the evaluation of preterm labor (PTL) or preterm premature rupture of membranes (PPROM), actual performance of the procedure was tracked. Fifty-nine patients were admitted with these diagnoses. Twenty-three patients (39%) were offered amniocentesis and 36 patients (61%) were not offered amniocentesis as part of the clinical protocol. Seven (30%) patients of those offered an amniocentesis underwent the procedure. The predominant reasons for not performing an amniocentesis were patient refusal and provider discomfort. In conclusion, implementation of amniocentesis to evaluate for subclinical infection/inflammation in the setting of PTL or PPROM proved difficult, as only 7 of 59 (11.9%) patients admitted with these diagnoses actually received an amniocentesis.     

Nitric oxide metabolite levels in preterm labor

AIM: To investigate the role of nitric oxide metabolites as markers of infection in subjects with preterm labor or preterm premature rupture of membranes (PTPROM). PTPROM means that there was spontaneous rupture of fetal membrane before the onset of labor and gestational age was <37 weeks. This occurs because of imbalance between matrix metalloproteinase and tissue inhibitor of matrix metalloproteinase. The cause of this imbalance that leads to degradation of collagen causing PTPROM is infection. The bactericidal, fungicidal, viricidal and tumoricidal activities of macrophages are determined in part by elaboration of nitric oxide, hence nitric oxide levels have been found to be increased in infections. METHODS: During an 18-month period 50 women with preterm labor or PTPROM and 50 controls were enrolled prospectively. Blood and urine samples were obtained for analysis of nitric oxide metabolites. Patients with known causes of preterm labor were excluded. RESULT: The nitric oxide metabolites, which included both nitrite levels and citrulline levels were significantly higher both in blood as well as urine in patients with preterm labor and PTPROM compared to controls. Serum nitrite levels in subjects with preterm labor were 376.5 +/- 345 nmol/L while in subjects with PTPROM they were 295.7 +/- 161.1 nmol/L and in controls the levels were 62.7 +/- 33.9 nmol/L. Serum citrulline levels in subjects with preterm labor were 5293.8 +/- 2916.7 nmol/L; in PTPROM they were 6536.6 +/- 609.91 nmol/L and in controls they were 949.8 +/- 67.1 nmol/L. On comparing patients with preterm labor, those in whom preterm labor could not be inhibited had statistically significant higher levels of nitrite in both serum and urine (482.9 +/- 387.7 nmol/L and 754.5 +/- 336.5 nmol/L, respectively) compared to patients in whom labor could be inhibited (172.2 +/- 61.9 nmol/L and 401.8 +/- 236.9 nmol/L, respectively). The citrulline levels were also higher among the group who delivered preterm for both serum and urine (5355.4 +/- 3229.7 nmol/L and 11 482.8 +/- 2541.4 nmol/L, respectively) compared to patients in whom labor could be inhibited (5260.2 +/- 2897.08 nmol/L and 10 651.4 +/- 1502.7 nmol/L, respectively) but this did not reach statistical significance. CONCLUSION: Higher nitric oxide metabolites in women with preterm labor are marker of subclinical infection.     

Prediction of delivery among women with early preterm labor by means of clinical characteristics alone

OBJECTIVE: This study was undertaken to assess whether individual clinical factors or combinations thereof could be used to accurately predict the risk of delivery within 1 week of admission among women with preterm labor and minimal cervical dilatation. STUDY DESIGN: We performed a case-control study of patients admitted to our institution with preterm labor and minimal cervical dilatation. A case patient was a patient who sought treatment with uterine contractions between 24 and 34 weeks' gestation with cervical dilatation 70 potential predictors was recorded. Statistical analysis consisted of bivariate and multivariable methods. We also generated a multivariable clinical predictive model with the purpose of detecting a proportion as high as possible of those destined to be delivered within 1 week (high sensitivity). We estimated that we would need 50 case patients and 150 control subjects to detect an odds ratio of 2.5 for risk factors with a prevalence of 20%, an alpha error of.05, a beta error of.20, and a control subject/case patient ratio of 3:1. RESULTS: Three variables were eligible for inclusion in our logistic models according to the bivariate analyses-bleeding on admission, substance abuse, and admission white blood cell count >/=14,000 cells/microL. The simplest and most favorable model included only 2 variables, bleeding and substance abuse, and yielded a sensitivity of 46% and a specificity of 76%. The full 3-variable model had similar test characteristics. For no model were we able to achieve a sensitivity >/=50%. CONCLUSION: The results of this case-control study suggest that combinations of clinical factors do not yield an adequate level of discrimination to be used alone for predicting the likelihood of delivery within 1 week among patients with minimal degrees of cervical dilatation.     

Myometrial elasticity determined by elastosonography to predict preterm labor

Abstract

Aim: To determine the utility of elastosonography (ES) combined to cervical length measurement to predict preterm labor.

Methods: One hundred twenty-seven women with pregnancies between 21 to 36 weeks of gestation without any risk factor for preterm labor were included in the study. All subjects underwent sonographic evaluation including fetal biometry, cervical length measurement and ES of uterine myometrium. Subcutaneous tissue was the reference point for ES evaluation. Tissue strain ratio values were obtained from all patients.

Results: Cervical length was a significant predictor for preterm delivery (AUC?=?0.958, p?<?0.001). Optimal cut-off value was obtained at 30?mm with 92% sensitivity and 81% specificity. Elastosonographic strain ratio was also a significant predictor for preterm delivery (AUC?=?0.827, p?<?0.001). Optimal cut-off value was obtained at 4.7 with 79% sensitivity and 91% specificity. In linear regression analysis, strain ratio (R^2?=?0.61, beta?=?0.171, p?=?0.03) and cervical length (R^2?=?0.61, beta?=??0.516, p?<?0.001) were significantly associated with preterm delivery. Cervical length?<?30?mm [39.1 (95 CI, 6.6–231.5, p?<?0.001)] and strain ratio?>?4.7 [24.5 (95 CI, 4.1–146.5, p?<?0.001)] were the risk factors for preterm delivery.

Conclusion: Elastosonographic evaluation of uterine myometrium was found to be significantly correlated with cervical length but cervical length measurement is a better predictor for preterm labor than ES.     

Progesterone supplementation for prevention of preterm labor: A randomized controlled trial

ObjectiveTo evaluate the efficacy of intramuscular progesterone in prevention of preterm labor in high risk cases.DesignRandomized controlled trial.SettingAin Shams Maternity hospital.Materials and methodsSingleton pregnant women in their second trimester with a history of previous preterm labor were divided into two groups: progesterone group: received 17-α-hydroxy progesterone caproate (Cidolut depot) one dose of 250mg IM once weekly until 36weeks and placebo group: received standard dose of placebo IM per week. Follow up till delivery.ResultsThe mean gestational age was 37.4±1.5 in progesterone group vs. 34.7±2.4 in placebo group (P<0.05). In the progesterone group 8 of 25 women delivered before completion of 37 weeks of gestation (32%) and 17 women delivered full term (68%). In placebo group, 13 of 25 women delivered before completion of 37weeks of gestation (52%) and 12 women delivered full term (48%).ConclusionOur findings support 17-α-hydroxy progesterone as a successful drug in the prevention and decreasing the rate of recurrent preterm labor.     

A comparison of three tocolytics for preterm labor: a randomized clinical trial

Abstract

Objective: To compare the efficacy and maternal side effects of nifedipine (N), magnesium sulfate (M), and indomethacin (I) for acute tocolysis.

Methods: In this single center randomized trial, women in preterm labor 24–32 weeks’ gestation received intravenous M, oral N, or I suppositories. The primary outcomes of interest were arrest of preterm labor (>48?h, ≥7 days), gestational age at delivery, and maternal side effects.

Results: Over a 38-month period, 301 women were allocated to receive M (90), N (114), or I (90). Gestational age at delivery (p?=?0.551) or arrest of labor >48?h, >7 days were similar between the three groups (p?=?0.199, 0.654). Hypotension and tachycardia were more common in N patients compared to women receiving M or I (p?=?0.003, 0.009). Patients receiving I had more fetal ductal constriction or oligohydramnios compared to M or N (p?=?0.001, 0.020) but, I women were tested more often. There was one case of pulmonary edema in the M group and one with plural effusion in the N group.

Conclusion: There were no differences in efficacy or in major maternal safety issues between the three tocolytic agents. Since there is no FDA approved tocolytic to treat preterm labor, clinicians should use the tocolytic that has afforded them the best results with the least maternal/neonatal side effects.