中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2010年
5期
398-402
,共5页
郑淑敏%王允锋%孙万卉%赵秀花
鄭淑敏%王允鋒%孫萬卉%趙秀花
정숙민%왕윤봉%손만훼%조수화
胎膜早破%引产%剖宫产术%回顾性研究
胎膜早破%引產%剖宮產術%迴顧性研究
태막조파%인산%부궁산술%회고성연구
Fetal membranes,premature rupture%Labor,induced%Cesarean section%Retrospective studies
目的 探讨妊娠35周以上胎膜早破孕妇的临床最佳干预时机. 方法对2005年1月1日至2009年12月31日在我院分娩的903例足月及近足月(孕周≥35周)、单胎头位且无其他合并症的胎膜早破孕妇的临床资料进行同顾性分析.按自然临产和缩宫素引产的不同时间分6组:1组为破膜后0～6 h自然临产孕妇269例;2组为破膜6～12 h自然临产孕妇161例;3组为破膜12～24 h自然临产孕妇75例;4组为破膜6～12 h未临产行缩宫素引产孕妇124例;5组为破膜12～24 h未临产行缩宫素引产孕妇98例;6组为破膜＞24 h未临产行缩宫素引产孕妇176例.分析各组孕妇的分娩结局及母婴并发症与破膜至分娩时间的关系. 结果 (1)903例胎膜早破孕妇中,破膜24 h内临床未干预的共681例,其中自然临产共505例,占74.2%.未干预者中430例在破膜12 h内自然临产,占63.2%,剖宫产率为20.7%(89/430);75例于破膜12～24 h自然临产,占11.0%,剖宫产率50.7%(38/75);176例破膜后24 h内仍未临产,占25.8%,剖宫产率为70.5%(124/176).(2)903例孕妇中破膜6、12、24 h行缩宫素引产者共398例(44.1%).破膜12 h缩宫素引产组(5组)的剖宫产率、宫内感染率、产褥病率和围产儿病率均低于破膜24 h缩宫素引产组(6组)[剖宫产率:52.0%(51/98)和70.5%(124/176);宫内感染率:6.1%(6/98)和22.7%(40/176);产褥病率:6.1%(6/98)和19.9%(35/176);围产儿病率:7.1%(7/98)和20.5%(36/176),P均＜0.01],但产后出血发生率两组之间比较差异无统计学意义[1.0%(1/98)和4.0%(7/176),P＞0.05]. 结论足月及近足月胎膜早破孕妇破膜12 h内自然临产率高,结局良好,故临床不必干预.破膜12 h仍未临产者,应积极引产.等待破膜24 h后再引产,则增加剖宫产率及母婴并发症的发生率.
目的 探討妊娠35週以上胎膜早破孕婦的臨床最佳榦預時機. 方法對2005年1月1日至2009年12月31日在我院分娩的903例足月及近足月(孕週≥35週)、單胎頭位且無其他閤併癥的胎膜早破孕婦的臨床資料進行同顧性分析.按自然臨產和縮宮素引產的不同時間分6組:1組為破膜後0～6 h自然臨產孕婦269例;2組為破膜6～12 h自然臨產孕婦161例;3組為破膜12～24 h自然臨產孕婦75例;4組為破膜6～12 h未臨產行縮宮素引產孕婦124例;5組為破膜12～24 h未臨產行縮宮素引產孕婦98例;6組為破膜＞24 h未臨產行縮宮素引產孕婦176例.分析各組孕婦的分娩結跼及母嬰併髮癥與破膜至分娩時間的關繫. 結果 (1)903例胎膜早破孕婦中,破膜24 h內臨床未榦預的共681例,其中自然臨產共505例,佔74.2%.未榦預者中430例在破膜12 h內自然臨產,佔63.2%,剖宮產率為20.7%(89/430);75例于破膜12～24 h自然臨產,佔11.0%,剖宮產率50.7%(38/75);176例破膜後24 h內仍未臨產,佔25.8%,剖宮產率為70.5%(124/176).(2)903例孕婦中破膜6、12、24 h行縮宮素引產者共398例(44.1%).破膜12 h縮宮素引產組(5組)的剖宮產率、宮內感染率、產褥病率和圍產兒病率均低于破膜24 h縮宮素引產組(6組)[剖宮產率:52.0%(51/98)和70.5%(124/176);宮內感染率:6.1%(6/98)和22.7%(40/176);產褥病率:6.1%(6/98)和19.9%(35/176);圍產兒病率:7.1%(7/98)和20.5%(36/176),P均＜0.01],但產後齣血髮生率兩組之間比較差異無統計學意義[1.0%(1/98)和4.0%(7/176),P＞0.05]. 結論足月及近足月胎膜早破孕婦破膜12 h內自然臨產率高,結跼良好,故臨床不必榦預.破膜12 h仍未臨產者,應積極引產.等待破膜24 h後再引產,則增加剖宮產率及母嬰併髮癥的髮生率.
목적 탐토임신35주이상태막조파잉부적림상최가간예시궤. 방법대2005년1월1일지2009년12월31일재아원분면적903례족월급근족월(잉주≥35주)、단태두위차무기타합병증적태막조파잉부적림상자료진행동고성분석.안자연임산화축궁소인산적불동시간분6조:1조위파막후0～6 h자연임산잉부269례;2조위파막6～12 h자연임산잉부161례;3조위파막12～24 h자연임산잉부75례;4조위파막6～12 h미임산행축궁소인산잉부124례;5조위파막12～24 h미임산행축궁소인산잉부98례;6조위파막＞24 h미임산행축궁소인산잉부176례.분석각조잉부적분면결국급모영병발증여파막지분면시간적관계. 결과 (1)903례태막조파잉부중,파막24 h내림상미간예적공681례,기중자연임산공505례,점74.2%.미간예자중430례재파막12 h내자연임산,점63.2%,부궁산솔위20.7%(89/430);75례우파막12～24 h자연임산,점11.0%,부궁산솔50.7%(38/75);176례파막후24 h내잉미임산,점25.8%,부궁산솔위70.5%(124/176).(2)903례잉부중파막6、12、24 h행축궁소인산자공398례(44.1%).파막12 h축궁소인산조(5조)적부궁산솔、궁내감염솔、산욕병솔화위산인병솔균저우파막24 h축궁소인산조(6조)[부궁산솔:52.0%(51/98)화70.5%(124/176);궁내감염솔:6.1%(6/98)화22.7%(40/176);산욕병솔:6.1%(6/98)화19.9%(35/176);위산인병솔:7.1%(7/98)화20.5%(36/176),P균＜0.01],단산후출혈발생솔량조지간비교차이무통계학의의[1.0%(1/98)화4.0%(7/176),P＞0.05]. 결론족월급근족월태막조파잉부파막12 h내자연임산솔고,결국량호,고림상불필간예.파막12 h잉미임산자,응적겁인산.등대파막24 h후재인산,칙증가부궁산솔급모영병발증적발생솔.
Objective To explore the optimal time for clinical interventions on full-term or nearterm pregnant women with premature rupture of membranes(PROM). Methods A retrospective study was conducted on clinical data of 903 healthy, full-term or near-term (gestational age ≥ 35 weeks), singleton pregnant women with PROM, who admitted to our hospital from January 1, 2005 to December 31, 2009. All subjects were divided into 6 groups: women in group 1 were those fell into spontaneous labor within 6 h after PROM (n=269, 29.8%); women in group 2 were in spontaneous labor between 6 to 12 h after PROM (n= 161, 17.8%) ; women in group 3 were in spontaneous labor at 12 to 24 h after PROM (n = 75, 8. 3%); In group 4 oxytocin was administered for induction for women not in labor at 6 to 12 h after PROM (n= 124, 13.7%) ; Group 5 included those women who were not in labor at 12 to 24 h after PROM and oxytocin induction was offered (n=98, 10. 9%);Group 6 consisted of those women who were not in labor over 24 h after PROM and oxytocin induction was offered (n = 176, 19. 5%). The maternal and neonatal complications and outcomes of all pregnancies were reviewed and compared. Results Among the 903 cases, the total number of women without any medical interventions was 681, among which 505 (74.2%) fell into spontaneous labor, including 430 (63.2%) within 12 h with a cesarean section rate(CSR) of 20.7%(89/430), 75 (11.0%) at 12-24 h after PROM with the CSR of 50.7% (38/75), and 176 (25.8%) did not go into labor spontaneously (group 6) with a CSR of 70. 5% (124/176). (2) Among the 930 women, 398were induced at 6, 12 and 24 h after PROM. The CSR, incidence of intrauterine infection, puerperal morbidity and perinatal mortality rate in group 5 were significantly lower than those of group 6 [CSR:52.0%(51/98) vs 70. 5%(124/176); intrauterine infection: 6. 1%(6/98) vs 22. 7%(40/176);puerperal morbidity: 6. 1% (6/98) vs 19.9% (35/176); perinatal mortality: 7. 1% (7/98) vs 20.5%(36/176),all P＜0. 01], but no difference was found in the incidence of postpartum hemorrhage [1.0%(1/98) vs 4.0%(7/176), P＞0.05]. Conclusions Intervention is not recommended within 12 h after PROM in full term or near term gravidas. However, induction of labor should be offered thereafter. However, the CSR and incidence of maternal and neonatal complications rise up if induction of labor postponed to 24 h after PROM.
