胎膜早破279例临床分析

目的探讨胎膜早破病因及其分娩方式、新生儿结局。方法回顾性分析279例胎膜早破者病历资料,依破膜到分娩结束时间、不同孕周,同期是否破膜分组,对其分娩方式以及新生儿结局进行对比分析。结果多次妊娠的胎膜早破发生率最高(39.42%);其次是头盆不称、阴道炎、胎位异常及多胎妊娠。胎膜破裂距分娩结束不足24h者222例,阴道和手术分娩分别占81.08%和18.92%;新生儿窒息7例、感染1例;胎膜破裂距分娩结束超过24h57例,阴道和手术分娩依次占77.19%和22.81%,新生儿窒息6例、感染7例;两组分娩方式比较差异无显著性,新生儿窒息、感染差异有显著性。早产28例中,新生儿窒息5例、围生儿死亡2例、新生儿感染4例、颅内出血2例、特发性呼吸窘迫综合征2例;251例足月产中,新生儿窒息8例、新生儿感染4例、无IRDS、无新生儿颅内出血及围生儿死亡;两组新生儿窒息、感染、颅内出血、IRDS差异有显著性。胎膜早破组自然分娩222例,剖宫产率20.43%,低于同期无胎膜早破组54.03%的剖宫产率,差异有统计学意义(P<0.05)。结论对胎膜早破应该预防病因,及早处理,以降低孕产妇难产率和减少孕产妇及围产儿发病率;胎膜早破并非难产的主要原因,应鼓励其阴道分娩。

The Clinical Analysis of 279 Cases with Premature Rupture of Membrane

Objective To investigate the reasons of premature rupture of membrane(PROM)and its association with delivery option and neonatal outcome.Methods Medical records of 279 pregnant women with PROM were reviewed retrospectively.The delivery option and neonatal outcome were analyzed and compared between the women with delivery less than 24 hours and more than 24 hours after PROM with different gestation weeks,and between women with and without PROM.Results High frequency pregnancy had the highest PROM prevalence of 39.42%,which was followed by fetal-pelvic disproportion,vaginitis,malpresentation and multiple pregnancy.Among 222 women with delivery less than 24 hours after PROM,there were 81.08% vaginary deliveries and 18.92% by cesarean sections.Asphyxia neonatorum occurred in 7 infants and one had neonatal infection.While among 57 women with delivery more than 24 hours after PROM,there were 77.19% vaginary deliveries and 22.81% cesarean sections,and 17.86% infants with asphyxia neonatorum and 7 infants with infection.There was no significant difference in delivery option while significant difference existed in asphyxia neontorum and infection rate.There were 28 premature infants,5 infants with asphyxia neonatorum,4 with infection,2 with intractanial hemorrhage,2 with idiopathic respiratory distress syndrome(IRDS)and 2 with perinatal deaths.Among 251 term infants,8 had asphyxia neonatorum and 4 had infection,No IRDS and intractanial hemorrhageand occurred.There was significant difference in the rate of asphyxia neonatorum,infection,intractanial hemorrhage and IRDS.The CS rate of PROM group was 20.43%,which was significantly lower than that of normal pregnancy women(54.03%).Conclusion If the origin of premature rupture of membrane should be monitored and managed as early as possible,conducte dystocia rate may be controlled so that the morbidity of pregnany women and infants can be lowered.Vaginal delivery should also be advocated for PROM women because PROM is not the direct reason of dystocia.