摘要目的 探讨胎膜早破(premature rupture of membrane,PROM)危险因素、早产胎膜早破独立危险因素,以及对分娩方式、妊娠结局的影响。方法 回顾性分析2013-01至2016-03在陆军总医院住院分娩的1105例胎膜早破孕妇的相关临床资料。结果 (1)陆军总医院胎膜早破发生率16.3%,其中早产胎膜早破发生率为2.8%,足月胎膜早破发生率为13.5%。(2)导致胎膜早破的危险因素主要为:流产及引产史、生殖道感染、妊娠糖尿病、妊娠合并贫血、妊娠高血压、宫腔内压力增加(胎位异常、多胎妊娠、巨大儿、羊水过多)、子宫畸形等。(3)PROM组生殖道感染、多胎妊娠、胎位异常(头盆不称/臀位/横位)、流产及引产史、妊娠高血压、妊娠糖尿病、前置胎盘、妊娠合并贫血所占比例明显高于足月胎膜早破组,且差异有统计学意义。(4)生殖道感染、多胎妊娠、胎位异常、流产及引产史、前置胎盘以及妊娠合并贫血均是影响PROM发生的独立危险因素(OR=3.387,95%CI 1.468~13.337;OR=3.533,95% CI 1.892~13.993;OR=1.680,95% CI 1.005~2.807;OR=1.635,95%CI 1.127~2.372;OR=3.020,95% CI 1.841~15.977;OR=3.177,95% CI 1.294~7.798,P<0.05)。(5)PPROM组剖宫产率及产褥感染、新生儿肺炎、新生儿窒息的发生率显著高于TPROM组,且差异有统计学意义(P<0.05)。结论 胎膜早破病因复杂,了解其危险因素对积极防治该疾病有重要意义,尤其是早产胎膜早破的防治,可有效预防母婴不良妊娠结局的发生。
Abstract：Objective To study the high risk factors of premature rupture of membranes(PROM), the independent risk factors of preterm premature rupture of membranes(PPROM)and their effect on the modes of delivery and pregnancy outcomes.Methods The clinical data of 1105 pregnant women with PROM treated in the Army General Hospital between January 2013 and March 2016 were retrospectively analyzed.Results (1)The incidence of PROM was 16.3%,that of PPROM was 2.8% and that of term premature rupture of membranes(TPROM) was 13.5%.(2)The main risk factors of PROM were the history of abortion or induced labor,reproductive tract infections,gestational diabetes,pregnancy with anemia, gestational hypertension disease, intrauterine pressure increases(abnormal fetal position, multiple pregnancies, macrosomia, and polyhydramnios),and uterine malformation.(3)The proportion of reproductive tract infections,multiple pregnancies,abnormal fetal positions,previous abortion or induced labor,gestational hypertension disease,gestational diabetes,placenta previa,and pregnancy with anemiain PPROM group was much higher than that in TPROM group,and the difference was significant.(4)The proportion of reproductive tract infections,multiple pregnancies,abnormal fetal positions,previous abortion or induced labor,placenta previa,and pregnancy with anemia were independent risk factors of PPROM(OR=3.387, 95%CI:1.468-13.337;OR=3.533, 95%CI:1.892-13.993,OR=1.680,95%CI:1.005-2.807,OR=1.635,95%CI:1.127-2.372,OR=3.020,95%CI:1.841-15.977,OR=3.177,95%CI:1.294-7.798,P<0.05).(5).The incidence of cesarean sections,puerperal infections,neonatal pneumonia,and neonatal asphyxia in PPROM group was significantly higher than that in TPROM group (P<0.05).Conclusions The risk factors of PROM are diverse and complicated. A good knowledge of the risk factors has important implications for clinical prevention and treatment of PROM and PPROM in particular.
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