未足月胎膜早破潜伏期与妊娠结局的关系

目的分析不同孕周发生的未足月胎膜早破(PPROM)及其潜伏期(latency period)对妊娠结局的影响探讨临床最佳干预时机。方法对2010年1月1日至2013年12月31日在我院分娩的383例(28³6+6周)单胎头位且无其他并发症的PPROM病例及其新生儿的临床资料进行回顾性分析。按发生PPROM的孕周分为3个组:(1)孕2836+6周)单胎头位且无其他并发症的PPROM病例及其新生儿的临床资料进行回顾性分析。按发生PPROM的孕周分为3个组:(1)孕28³1+6周;(2)孕3231+6周;(2)孕32³3+6周;(3)孕3433+6周;(3)孕34³6+6周。根据潜伏期不同,每个孕周段进一步分为两个组,分别对比两组不同潜伏期PPROM与妊娠结局的关系。结果孕2836+6周。根据潜伏期不同,每个孕周段进一步分为两个组,分别对比两组不同潜伏期PPROM与妊娠结局的关系。结果孕28³1+6周组潜伏期在72 h以内的早产儿死亡率和支气管肺发育不良率显著高于潜伏期72 h以后者。孕3231+6周组潜伏期在72 h以内的早产儿死亡率和支气管肺发育不良率显著高于潜伏期72 h以后者。孕32³3+6周组潜伏期在72 h之内者与潜伏期在72 h之后的PPROM母儿主要妊娠结局差异均无统计学意义(P>0.05)。孕3433+6周组潜伏期在72 h之内者与潜伏期在72 h之后的PPROM母儿主要妊娠结局差异均无统计学意义(P>0.05)。孕34³6+6周组潜伏期在12 h之内者与潜伏期在12 h之后者的母儿主要妊娠结局差异均无统计学意义(P>0.05)。结论对孕2836+6周组潜伏期在12 h之内者与潜伏期在12 h之后者的母儿主要妊娠结局差异均无统计学意义(P>0.05)。结论对孕28³1+6周PPROM可采取促胎肺成熟,预防感染和抑制宫缩处理,在没有禁忌证的情况下,尽可能延长潜伏期72 h以上或34周后终止妊娠;对3231+6周PPROM可采取促胎肺成熟,预防感染和抑制宫缩处理,在没有禁忌证的情况下,尽可能延长潜伏期72 h以上或34周后终止妊娠;对32³3+6周PPROM没有证据支持延长孕周72 h对妊娠结局有好处;对孕3433+6周PPROM没有证据支持延长孕周72 h对妊娠结局有好处;对孕34³6+6周PPROM应考虑尽快终止妊娠;

Relationship between the latency of preterm premature rupture of membranes with pregnancy ;outcome

Objective To explore the effect of different gestational weeks and latency period on pregnancy outcome in preterm premature rupture of membrane and the optimal timing of clinical intervention. Methods A retrospective study was conducted on clinical data of 383 （between 28-36＋6 weeks）, healthy singleton pregnant women with PPROM and neonatal information, who admitted to our hospital from January 1, 2010 to December 31, 2013.According to the different clinical treatment and different gestational weeks all subjects were divided into 3 groups： （1） 28-31＋6 gestational weeks; （2） 32-33＋6 gestational week;（3） 34-36＋6 gestational weeks;each gestational age group were further divided into two groups, analysis the relationship between different groups of pregnant women with different latency and the maternal and neonatal outcomes. Results In 28-31＋6 weeks of gestation group, neonatal mortality and bronchopulmonary dysplasia were significantly higher in group of latent period within 72 h than that in group of latent period over 72 h. In 32-33＋6 weeks group, there was no statistic difference of maternal and neonatal outcomes between the group of latent period over 72 h and the group of within 72 h. In 34-36＋6 weeks group, there was no statistic difference of maternal and neonatal outcomes between the group of latent period over 12 h and the group of within 12 h. Conclusions The patients with PPROM at 28-31＋6 gestational weeks, the suitable measures to treat are promoting fetal lung maturation, preventing infection, tocolysis to prolong latency period more than 72 h or until 34 weeks if there were no contraindications. The patients with PPROM at 32-33＋6 gestational weeks, There is no evidence to support prolong gestational age 72 h is good for pregnancy outcome. To the patients with PPROM at 34-36＋6＆amp;nbsp;gestational weeks, the suitable measure is proceeding to delivery as early as possible.