129例早产合并胎膜早破相关因素分析

目的:分析早产合并胎膜早破的相关因素,制定预防措施,降低围产儿病率和病死率。方法:对129例早产合并胎膜早破者进行回顾性分析。结果:不同孕周胎膜早破发生的早产其围产儿各种疾病的发生率和病死率差异显著,孕周>34周者其围产儿疾病发生率明显降低而存活率明显增加。因臀位、早产(流产)史、阴道炎、妊娠期高血压疾病、双胎等胎膜早破导致早产者分别占14.7%、13.2%、12.4%、9.3%、6.9%,不明原因者所占比例最高为29.5%。结论:加强对上述高危妊娠者的监测和管理可降低早产发生率。     

产科临床早产危险因素的研究及分析

目的:分析导致产科早产的危险因素及预防.方法:选取2018年1月至2019年7月产科接收的51例早产产妇与50例足月产妇为研究对象,对产妇及胎儿的基本资料进行回顾性分析,通过对比足月与早产产妇的基本资料,分析引起产妇临床早产的危险因素,以为早产的预防提供有力参考.结果:在孕次与年龄上,足月产妇与早产产妇对比差异无统计学意义(P>0.05);早产孕妇在流产次数大于2次、羊水过多、妊娠高血压、胎膜早破、前置胎盘与胎位不正的发生率分别为27.45%、25.49%、19.61%、13.72%、17.65%、7.84%,足月孕妇分别为6.00%、6.00%、4.00%、2.00%、4.00%、0.00%,组间对比差异有统计学意义(P<0.05).结论:流产、羊水过多、妊娠高血压、胎膜早破、前置胎盘与胎位不正等因素均是引起产科早产的危险因素,因此需加强预防及干预.     

胎膜早破合并早产86例临床分析

目的研究胎膜早破合并早产的主要因素、分娩时机、分娩方式、早产儿结局.方法选择妊娠28～36()6周胎膜早破合并早产者86例,进行回顾性病例对照分析.结果胎膜早破合并早产的原因主要有流产、早产、引产史、臀位、双胎、妊娠高血压综合征等.阴道分娩48例(55.81%),剖宫产38例(44.19%).剖宫产手术指征主要为胎儿窘迫15例,占39.47%.结论≤34孕周终止妊娠者,早产儿并发症较多早产儿对缺氧耐受性差,常需会阴切开或剖宫产结束分娩,以降低RDS和颅内出血的发生.     

胎膜早破性早产主要原因及对早产儿的影响(附102例临床分析)

目的探讨胎膜早破性早产主要因素及对早产儿的影响。方法回顾性分析102例胎膜早破性早产的主要高危因素,将其分为阴式分娩组和剖宫产组,对不同分娩方式对早产儿的影响作比较分析。结果臀位、引流产史、双胎、阴道炎是引起胎膜早破性早产的主要因素,胎龄越小死亡率明显增高,特别是胎龄<32周者;剖宫产组和阴式分娩组中早产儿的发病率(尤其颅内出血等)差异有显著性(P<0.05)。结论胎膜早破性早产是新生儿发病和死亡的主要原因,正确治疗和选择适当的分娩方式是降低新生儿并发症的重要措施。     

早产危险因素meta分析

目的　综合分析中国早产发生的危险因素。方法　采用meta分析对国内 1994~2003年发表的有关早产危险因素的文献进行汇总、归纳和定量综合分析。结果　前置胎盘、产前出血、胎膜早破、多胎、臀位、妊高症、流产史、产前检查的合并OR值及其 95%C1分别为 7. 8781(5. 0103-12. 3876)、5. 4065(3. 009-8. 8552)、4. 4165(3. 2983-5. 9133)、4. 3601(2. 6414-7. 1973)、2. 7070(1. 8331~3. 9972)、2. 0432 (1. 3512-3. 0895)、1. 1651 (0. 7518 ~1. 8057)、0. 2946 (0. 2269 -0. 3824)。结论　前置胎盘、产前出血、胎膜早破、多胎、臀位、妊高症为早产的危险因素,流产史与早产的的关系尚不确定,产前检查为早产的保护因素。     

胎膜早破合并早产86例临床分析

目的:研究胎膜早破合并早产的主要因素、分娩时机、分娩方式、早产儿结局。方法:选择妊娠28-36r6周胎膜早破台并早产者86例,进行回顾性病例对照分析。结果:胎膜早破合并早产的原因主要有流产、早产、引产史、臀位、双胎、妊娠高血压综合征等。阴道分娩48例(55.81％),剖宫产38例(44.19％)。剖宫产手术指征主要为胎儿窘迫15例.占39.47％。结论:≤34孕周终止妊娠者,早产儿并发症较多:早产儿对缺氧耐受性差,常需会阴切开或剖官产结束分娩,以降低RDS和颅内出血的发生。     

185例早产原因分析

目的:探讨引起早产的相关因素,为临床制定干预早产的具体措施提供资料。方法:回顾性分析185例早产患者的临床资料。结果:胎膜早破、多胎妊娠、妊娠期肝内胆汁淤积症、前置胎盘、妊娠高血压疾病是引起早产主要因素。结论:加强孕期保健,预防胎膜早破,是降低早产发生的关键。     

早产合并胎膜早破110例分析

目的探讨早产合并胎膜早破(PPROM)发生的危险因素及降低围生儿病死率的恰当处理方法。方法对我院2005~2007年间早产合并胎膜早破110例孕妇进行回顾性分析。结果感染、臀位、多胎、早产流产史及妊高征占PPROM病因的前5位;孕周<34周围生儿病死率显著高于≥34周,差异有统计学意义(P<0.01)。结论提高早产合并胎膜早破的预防及诊断水平,适当延长孕龄、促胎肺成熟,尽可能延至34周以后分娩,可望降低围生儿病死率。     

未足月胎膜早破499例临床分析

目的:探讨未足月胎膜早破的临床特征和治疗策略。方法:回顾性分析河北省秦皇岛市妇幼保健院2005～2008年收治的未足月胎膜早破患者499例的临床资料。结果:未足月胎膜早破的发病率是3.1%;发生未足月胎膜早破的相关因素依次是感染、既往早产或流产史、子宫张力高、胎膜受力不均等;其围生儿并发症以早产、胎儿窘迫、新生儿呼吸窘迫综合征为主;其围生儿结局与孕周直接相关。结论:胎膜早破是早产的主要原因。若临床无感染征象,应尽量保胎治疗至34周,适时终止妊娠。     

早产合并胎膜早破221例分析

目的:探讨早产合并胎膜早破的原因,分析围产儿的并发症,寻找终止妊娠的时机。方法:对1998年1月-2001年12月间221例早产合并胎膜早破病例资料进行回顾性分析。结果:早产合并胎膜早破占分娩总数的2.27%,流产引产史、臀位、阴道炎、双胎为主要因素,在处理上积极保胎,尽可能让妊娠延续到34周以上,并争取促胎肺成熟治疗,减少新生儿RDS发生,但抑制宫缩治疗的效果不能肯定,同时预防性应用抗生素,一旦出现感染征象,不论胎龄高低均应终止妊娠。结论:恰当处理早产合并胎膜早破,将减少早产儿并发症,降低早产儿病死率的关键。     

妊娠期糖尿病患者发生自发性早产的危险因素和预防措施研究

目的研究影响妊娠期糖尿病(GDM)患者发生自发性早产的危险因素,并通过预测模型研究其预测方案。方法通过随机抽样纳入2016年2月-2019年3月住院治疗的GDM患者,纳入GDM发生自发性早产的患者100例,GDM无自发性早产的患者100例,先对比两组临床基线资料,然后进行单因素及多因素回归分析,计算影响结果的独立危险因素,通过预测模型ROC分析预测价值。结果两组临床基线资料中,妊娠年龄、月经初潮年龄、月经周期紊乱史、自然流产史、糖尿病家族史、孕前体质指数(BMI)、妊娠期感染史等比较,差异均有统计学意义(均P<0.05)。单因素和多因素Logistics回归分析中,月经周期紊乱史、妊娠期感染史两个因素对自发性早产均无影响。妊娠年龄、月经初潮年龄、自然流产史、糖尿病家族史、孕前BMI为影响GDM患者发生自发性早产的独立危险因素。ROC预测模型结果显示,孕前BMI的AUC最高,自然流产史AUC最低为0.645,灵敏度最高为孕前BMI(85%);灵敏度最低为糖尿病家族史(57%);特异度最高为糖尿病家族史(76%),特异度最低为妊娠年龄(46%)。多因素联合做ROC分析可知,AUC=0.873,灵敏度=87%,特异度=73%,95%CI=0.819~0.916。结论妊娠年龄、月经初潮年龄、自然流产史、糖尿病家族史、孕前BMI为影响GDM发生自发性早产的独立危险因素,多因素联合对于预测GDM的发展有着较高的灵敏度及特异度,具有较高的临床价值。     

History of fetal loss and other adverse pregnancy outcomes in relation to subsequent risk of preterm delivery

Objective: To evaluate the association between maternal reproductive history and preterm delivery. Methods: The 312 preterm delivery cases, studied in aggregate, and in subgroups (spontaneous preterm labor, preterm premature rupture of membranes, medically induced preterm delivery, moderate preterm delivery [gestational age at delivery 34–36 weeks], and very preterm delivery [gestational age at delivery <34 weeks]), were compared with 424 randomly selected women who delivered at term. Maternal medical records provided information on maternal reproductive history, pregnancy outcome, as well as sociodemographic characteristics. Using multivariate logistic regression, we derived maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: A history of 2+ miscarriages was ( OR = 2.2; 95% CI 1.2–3.9), but a history of 2+ prior induced abortions (OR = 1.2; 95% CI 0.7–2.0) was not, associated with preterm delivery in the index pregnancy. Analyses of preterm delivery subgroups indicated that a history of 2+ miscarriages was associated with an increasedrisk of spontaneous preterm labor (OR = 2.6; 95% CI 1.2–2.8), preterm premature rupture of membrane (OR = 1.8; 95% 0.7–4.4), and medically induced preterm delivery (OR = 1.9; 95% CI 0.8–4.2), though only the former approached statistical significance. Excess risk of preterm delivery was associated with maternal prior history of delivering a stillborn infant (OR = 10.7), a prior history of delivering a newborn that later died during the neonatal period (OR = 3.2), and a prior history of having a pregnancy complicated by spontaneous preterm delivery (OR = 6.0). Generally these associations were evident for each subgroup of preterm delivery, though inferences were often hindered by our relatively small sample size. Conclusions: These results support the hypothesis that maternal adverse reproductive history is associated with an increased risk of preterm labor and delivery.     

Maternal asthma and risk of preterm delivery

PURPOSE: We studied the relation between maternal history of asthma and preterm delivery. METHODS: The 312 preterm delivery cases, studied in aggregate, and in subgroups (spontaneous preterm labor, preterm premature rupture of membranes, medically induced preterm delivery), were compared with 424 randomly selected women who delivered at term. Maternal medical records provided information on maternal lifetime asthma status, pregnancy outcome, and sociodemographic characteristics. Using multivariate logistic regression, we derived maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Maternal history of asthma was associated with an increased risk of preterm delivery overall (OR = 2.37; 95% CI 1.15-4.88). Analyses of preterm delivery sub-groups indicated that maternal history of asthma was associated with at least a doubling in risk of spontaneous preterm labor (OR = 2.35; 95% CI 0.84-6.58) and medically induced preterm delivery (OR = 2.69; 95% CI 1.11-6.53), though only the latter approached statistical significance. There was some evidence of a modest association between maternal asthma and risk of preterm premature rupture of membranes (OR = 1.63; 95% CI 0.50-5.33). CONCLUSIONS: These results support the hypothesis that maternal asthma is associated with an increased risk of preterm labor and delivery.     

Sexual activity and onset of preterm labour

In this prospective study, an attempt was made to determine the relationship between coitus and onset of labor. 140 pregnant women at and beyond 28 weeks of pregnancy were studied. Women with clinically evident causes of preterm labor like incompetent os, hydramnios, twins, and antepartum hemorrhage were excluded. Cases with abnormal presentations were also excluded. These patients knew their last menstrual period. Detailed history of any symptoms of lower genital tract infection was requested. 79.29% of the women were between 20 and 29 years of age. Both primigravidas and multigravidas were included. Out of 42 women with history of regular coitus during pregnancy, 17 women (40.48%) had preterm onset of labor, while 30 out of 98 (30.61%) had preterm onset of labor. There was no difference in the behavior of primigravidas and multigravidas. However, it was found that women who had coitus and symptoms of lower genital tract infection had a significantly higher incidence of preterm labor (46.88%) as compared with women with sexual activity but without such symptoms (20.O%) (p 0.005). When symptomatic women with positive sexual activity and negative coital history were compared, the incidence was similar: 46.88% and 48.07%, respectively. However, when symptomatic women with a positive history of sexual activity were compared with asymptomatic women without sexual activity, the occurrence of preterm labor was significantly more in the positive group: 20% vs. 10.87% in the negative history group (p .05). The significantly higher increase in preterm labor in women who had symptoms of lower genital tract infection and coitus implies that semen rather than coitus may affect the onset of labor. Further studies are required to learn more about this observation.     

Does evidence of inflammation on Papanicolaou smears of pregnant women predict preterm labor and delivery?

BACKGROUND: Preterm delivery is the most common cause of neonatal morbidity and mortality in the United States. There is evidence that cervicovaginal infection could predispose to preterm labor. This study explored a possible association of evidence of inflammation on an otherwise normal Papanicolaou smear obtained during pregnancy with subsequent preterm labor and preterm delivery. METHODS: Using a retrospective matched cohort design, we studied women who gave birth to live singleton infants at the University of Missouri Hospital and Clinics during a 21-month period. Papanicolaou smears were obtained from 1 to 8 months before delivery and were interpreted in the same cytopathology laboratory. Data pertaining to outcome variables and potential confounding variables were collected from hospital charts. RESULTS: Incidence rates were 14.4 percent for labor < 37 weeks' gestation (preterm labor), 12.3 percent for hospitalization for preterm labor, 9.9 percent for delivery < 37 weeks (preterm delivery), 2.6 percent for delivery < 34 weeks, and 7.5 percent for birth weight < 2500 g. On univariate and multivariate analyses, there were no significant differences in any outcome between the 293 women with inflammation and the 284 women without inflammation on Papanicolaou smear. Results were unchanged when the analysis was limited to the 412 women who received no antibiotics during pregnancy. Among the 38 women with a history of preterm labor or preterm delivery, those with cervical inflammation had a higher rate of preterm labor than those without inflammation. CONCLUSIONS: In the sample as a whole, there was little evidence that findings of inflammation on Papanicolaou smear constituted a risk factor for preterm labor or preterm delivery. The data suggest that inflammation could be associated with an increased risk in a subgroup of women at higher risk by virtue of their obstetric history.     

早产影响因素的前瞻性队列研究

目的  分析中国早产的流行现状及危险因素,为早产的预防提供参考依据。 方法  本研究数据来源于中国孕产妇队列研究·协和项目(Chinese Pregnant Women Cohort Study, CPWCS),通过问卷调查和医院信息系统(hospital information system, HIS)收集孕妇基本情况和分娩结局。采用SPSS 26.0软件进行χ²检验和多因素Logistic回归分析模型分析。 结果  5 671名孕妇中发生早产的例数为295例,占5.2%,不同地区早产率差异无统计学意义(χ² =0.591, P=0.771)。多因素分析结果显示：高龄、糖尿病史、早产史、胎盘早剥、胎膜早破、胎儿宫内窘迫、妊娠期高血压以及双胎是早产的危险因素(均有P < 0.05),而在自然分娩的孕妇中,高龄(OR=2.90, 95% CI: 1.67~5.06, P < 0.001)、胎膜早破(OR=6.17, 95% CI: 4.21~9.06, P < 0.001)、双胎(OR=17.72, 95% CI: 3.23~97.25, P=0.001)是早产的主要危险因素。 结论  早产的影响因素较多,准确识别危险因素,为孕妇提供科学合理的健康教育和个性化的防治措施是预防早产的重要手段。     

深圳市新生儿早产影响因素的病例对照研究

目的 探讨深圳市新生儿早产相关危险因素,为预防早产提供参考依据。 方法 在深圳市某妇幼保健院选取2015年1月1日－12月31日分娩的产妇和新生儿为研究对象,以妊娠满28周不足37周的200例新生儿母亲为病例组,妊娠满37周~42周的200例新生儿母亲为对照组。收集2014年1月1日－2015年12月31日SO₂、NO₂、PM₁₀、PM_2.5、CO和O₃逐日浓度。运用logistic回归模型分析早产影响因素。 结果 2014－2015年深圳市空气质量良好。病例组和对照组孕早期SO₂暴露浓度分别为(10.00±5.10)μg/m³、(8.66±5.03)μg/m³,NO₂暴露浓度分别为(38.23±15.98)μg/m³、(35.33±15.01)μg/m³,差异均有统计学意义(P＜0.05);病例组和对照组孕晚期PM₁₀暴露浓度分别为(54.26±28.00)μg/m³、(51.39±27.92)μg/m³,PM_2.5暴露浓度分别为(32.96±19.20)μg/m³、(30.11±18.36)μg/m³,差异均有统计学意义(P＜0.05)。病例组和对照组产妇年龄分别为(29.2±5.4)岁、(27.6±6.0)岁,家族早产史所占比例分别为38.5%、26.5%,大专及以上文化程度所占比例分别为62.5%、73.5%,差异均有统计学意义(P＜0.05)。进一步进行早产影响因素的多因素logistic回归分析发现:产妇年龄(OR=1.009, 95%CI:1.002~1.018)、有家族早产史(OR=1.308,95%CI:1.019~1.714)、孕晚期PM_2.5(OR=1.387,95%CI:1.112~1.579)、孕晚期PM₁₀(OR=1.267,95%CI:1.108~1.531)、孕早期SO₂(OR=1.118,95%CI:1.009~1.329)、孕早期NO₂(OR=1.106,95%CI:1.009~1.273)对早产有影响。 结论 深圳市空气SO₂、NO₂、PM₁₀、PM_2.5污染、产妇年龄和家族早产史与早产有关。     

The association between second-trimester maternal serum alpha-fetoprotein in 14-22 weeks and adverse pregnancy outcome

Aim of this study is to determine the risk of adverse pregnancy outcome by maternal serum alpha-fetoprotein (MSAFP) level. We followed 295 pregnant women from MSAFP screening in the 14th to 22th week of gestation until the end of pregnancy and information on pregnancy outcome have been recorded in questionnaires. Of 295 pregnant women, 270 had term labor and 25 had preterm labor. The frequencies of pregnancy outcomes were as following: 3 (1.01%) stillbirths, 25 (8.47%) preterm labor, and 10 (3.4%) preterm rupture of membranous (PROM), 15 (5.1%) pre-eclampsia, 23 (7.8%) oligohydramnious, and 1 (0.33%) miscarriage. The mean of preterm labor was significantly associated with the higher level of MSAFP (P = 0.021). The mean was 55.1 ng/cc in preterm labor and 41.1 ng/cc in term labor. Also, second trimester MSAFP levels were higher in women with pre-eclampsia (P < 0.001). The significant association was found between higher level of MSAFP with oligohydramnious (P < 0.001) and low birth weight (P < 0.001). Pregnancies with an elevated MSAFP level are associated with adverse obstetric outcomes and need more prenatal care.     

高原地区干预性早产原因分析与防治

目的 探讨高原地区干预性早产的成因以及对母婴的影响.方法 回顾性分析近5年316例干预性早产的相关资料.结果 高原地区干预性早产最主要病因为妊娠期高血压病、前置胎盘、胎盘早剥、妊娠期肝内胆汁淤积症等;干预性早产的剖宫产率显著高于足月分娩的剖宫产率,新生儿窒息、围生儿死亡率明显高于足月分娩的产妇;妊娠34周后早产儿存活率明显上升.结论 高原地区干预性早产成因复杂,与特有的气候、经济条件等相关,其发生率与高危妊娠管理密切相关,积极防治妊娠并发症,正确选择终止妊娠的方式及时机,提高新生儿科质量,有助于保证母婴的健康和安全.     

A study of the epidemiology of preterm labor.

A case-control study was designed in order to identify risk factors associated with preterm labor. All cases fulfilling the criteria of eligibility as preterm labor and attending the Ain Shams University Maternity Hospital during the period from January 1991 to June 1991 were included in the study. In the meanwhile, all women delivering after the 37th week of gestation during that period and in the same hospital and matched according to age (+/- 5 years) were included as the control group. Two hundred and thirty four cases and 216 controls were included in the study. An interview was performed to fill an epidemiologic and clinical questionnaire. Results showed that the lower the socioeconomic standard, the more the risk for preterm labor (p < 0.05), smoking whether active or passive is associated with preterm labor (p < 0.001), threatened or induced abortion, unwanted pregnancy, psychological trauma and surgical intervention during current pregnancy are associated with preterm labor (p < 0.001). History of preterm labor is associated with the present condition (p < 0.001). Anemia, hypertension, body weight less than 70 kgm are associated with preterm labor (p < 0.001).