孕产妇胎膜早破并发生殖道感染影响因素分析
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摘要
目的胎膜早破为产科常见并发症,本研究通过探讨孕产妇胎膜早破并发生殖道感染的影响因素,为临床应对胎膜早破提供依据。方法选择2016年1月-2017年10月医院产科收治的126例胎膜早破者为研究对象,选取同期非胎膜早破者60例为对照,对比分析两组患者分娩方式、围产儿结局、孕产妇生殖道感染率及母体并发症,多因素Logistic回归分析胎膜早破并发生殖道感染的相关因素。结果胎膜早破组生殖道感染总阳性率为66.67%明显高于对照组生殖道感染总阳性率20.00%(χ2=33.601,P<0.001),胎膜早破组胎盘早剥、产褥感染、产后出血发生率明显高于对照组(P<0.05),胎膜早破组顺产率低于对照组,不良妊娠结局发生率胎膜早破组高于对照组(P<0.05),胎膜早破并发生殖道感染的独立影响因素为孕周、破膜时间、免疫力低(P<0.05)。结论胎膜早破可能与孕产妇生殖道感染相关,孕周、破膜时间、免疫力低为影响胎膜早破并发生殖道感染的影响因素。
OBJECTIVE Premature rupture of membranes is a common complication in obstetrics department,the aim of the study is to explore the influencing factors for genital tract infections in puerperas with premature rapture of membranes so as to provide guidance for clinical treatment of the premature rapture of membranes.METHODS A total of 126 puerperas with premature rapture of membranes who were treated in the obstetrics department from Jan 2016 to Oct 2017 were recruited as the study objects,meanwhile,60 puerperas who did not have premature rupture of membranes were chosen as the control group.The delivery mode,perinatal outcomes,incidence of genital tract infections and maternal complications were observed and compared between the two groups of patients,and multivariate logistic regression analysis was performed for the related factors for the genital tract infections in the puerperas with premature rupture of membranes.RESULTS The total positive rate of genital tract infections of the premature rupture of membranes group was 66.67%,significantly higher than20.00% of the control group(χ2=33.601,P<0.001),the incidence rates of placental abruption,puerperal infections and postpartum hemorrhage were significantly higher in the premature rupture of membranes group than in the control group(P<0.05).The rate of eutocia of the premature rupture of membranes group was lower than that of the control group,and the incidence of adverse pregnancy outcomes of the premature rupture of membranes group was significantly higher than that of the control group(P<0.05).The gestational age,time of rupture of membranes and low immunity were the independent influencing factors for the genital tract infections in the puerperas with premature rupture of membranes(P<0.05).CONCLUSIONThe premature rupture of membranes may be associated with the genital tract infections in the puerperas.The gestational age,time of rupture of membranes and low immunity are the influencing factors for the genital tract infections in the puerperas with premature rupture of membranes.
OBJECTIVE Premature rupture of membranes is a common complication in obstetrics department,the aim of the study is to explore the influencing factors for genital tract infections in puerperas with premature rapture of membranes so as to provide guidance for clinical treatment of the premature rapture of membranes.METHODS A total of 126 puerperas with premature rapture of membranes who were treated in the obstetrics department from Jan 2016 to Oct 2017 were recruited as the study objects,meanwhile,60 puerperas who did not have premature rupture of membranes were chosen as the control group.The delivery mode,perinatal outcomes,incidence of genital tract infections and maternal complications were observed and compared between the two groups of patients,and multivariate logistic regression analysis was performed for the related factors for the genital tract infections in the puerperas with premature rupture of membranes.RESULTS The total positive rate of genital tract infections of the premature rupture of membranes group was 66.67%,significantly higher than20.00% of the control group(χ2=33.601,P<0.001),the incidence rates of placental abruption,puerperal infections and postpartum hemorrhage were significantly higher in the premature rupture of membranes group than in the control group(P<0.05).The rate of eutocia of the premature rupture of membranes group was lower than that of the control group,and the incidence of adverse pregnancy outcomes of the premature rupture of membranes group was significantly higher than that of the control group(P<0.05).The gestational age,time of rupture of membranes and low immunity were the independent influencing factors for the genital tract infections in the puerperas with premature rupture of membranes(P<0.05).CONCLUSIONThe premature rupture of membranes may be associated with the genital tract infections in the puerperas.The gestational age,time of rupture of membranes and low immunity are the influencing factors for the genital tract infections in the puerperas with premature rupture of membranes.
引文
[1]陈元花,裴雄越,王金香,等.胎膜早破与新生儿感染的相关性研究[J].中华医院感染学杂志,2018,28(14):2193-2196.
[2]Zhang LX,Sun Y,Zhao H,et al.A bayesian stepwise discriminant model for predicting risk factors of preterm premature rupture of membranes:a case-control study[J].Chin Med J(Engl),2017,130(20):2416-2422.
[3]冯颖.胎膜早破与孕妇生殖道感染的关系[J].中国实用医药,2018,13(22):34-36.
[4]Wu T,Shi J,Bao S,et al.Effect of premature rupture of membranes on maternal infections and outcome of preterm infants[J].Zhongguo Dang Dai Er Ke Za Zhi,2017,19(8):861-865.
[5]Li K,Yu H,Wang X,et al.Predictive value of procalcitonin or C-reactive protein for subclinical intrauterine infection in patients with premature rupture of membranes(PROM)[J].JPrenat Med,2016,10(3-4):23-28.
[6]Beucher G,Charlier C,Cazanave C.Diagnosis and management of intra-uterine infection:CNGOF Preterm Premature Rupture of Membranes Guidelines[J].Gynecol Obstet Fertil Senol,2018,46(12):1054-1067.
[7]Huret C,Pereira B,Collange V,et al.Premature rupture of membranes≥37weeks of gestation:predictive factors for labour onset within 24hours[J].Gynecol Obstet Fertil Senol,2017,45(6):348-352.
[8]夏亚莉.胎膜早破产妇外周血指标的改变对合并羊膜感染的诊断价值[J].中国实验诊断学,2018,22(10):1737-1739.
[9]Yasmina A,Barakat A.Prelabour rupture of membranes(PROM)at term:prognostic factors and neonatal consequences[J].Pan Afr Med J,2017,26:68.
[10]Chandra I,Sun L.Third trimester preterm and term premature rupture of membranes:is there any difference in maternal characteristics and pregnancy outcomes?[J].J Chin Med Assoc,2017,80(10):657-661.
[11]Lee SM,Park KH,Jung EY,et al.Frequency and clinical significance of short cervix in patients with preterm premature rupture of membranes[J].PLoS One,2017,12(3):e0174657.
[12]戴森戈,关飞云,张文淼,等.胎膜早破与生殖道感染的相关性探讨[J].中国计划生育学杂志,2016,24(1):46-49.
[13]Fouks Y,Many A,Orbach R,et al.Is there a role for placental cultures in cases of clinical chorioamnionitis complicating preterm premature rupture of membranes?[J].Am J Perinatol,2017,34(9):867-873.
[14]徐寒梅.胎膜早破对产妇产后感染及机体应激的影响[J].中国妇幼保健,2017,32(8):1641-1643.
[15]李小侠,解娟,詹颉,等.围产期胎膜早破与生殖道病原菌感染的分析[J].现代检验医学杂志,2016,31(4):90-92.
[2]Zhang LX,Sun Y,Zhao H,et al.A bayesian stepwise discriminant model for predicting risk factors of preterm premature rupture of membranes:a case-control study[J].Chin Med J(Engl),2017,130(20):2416-2422.
[3]冯颖.胎膜早破与孕妇生殖道感染的关系[J].中国实用医药,2018,13(22):34-36.
[4]Wu T,Shi J,Bao S,et al.Effect of premature rupture of membranes on maternal infections and outcome of preterm infants[J].Zhongguo Dang Dai Er Ke Za Zhi,2017,19(8):861-865.
[5]Li K,Yu H,Wang X,et al.Predictive value of procalcitonin or C-reactive protein for subclinical intrauterine infection in patients with premature rupture of membranes(PROM)[J].JPrenat Med,2016,10(3-4):23-28.
[6]Beucher G,Charlier C,Cazanave C.Diagnosis and management of intra-uterine infection:CNGOF Preterm Premature Rupture of Membranes Guidelines[J].Gynecol Obstet Fertil Senol,2018,46(12):1054-1067.
[7]Huret C,Pereira B,Collange V,et al.Premature rupture of membranes≥37weeks of gestation:predictive factors for labour onset within 24hours[J].Gynecol Obstet Fertil Senol,2017,45(6):348-352.
[8]夏亚莉.胎膜早破产妇外周血指标的改变对合并羊膜感染的诊断价值[J].中国实验诊断学,2018,22(10):1737-1739.
[9]Yasmina A,Barakat A.Prelabour rupture of membranes(PROM)at term:prognostic factors and neonatal consequences[J].Pan Afr Med J,2017,26:68.
[10]Chandra I,Sun L.Third trimester preterm and term premature rupture of membranes:is there any difference in maternal characteristics and pregnancy outcomes?[J].J Chin Med Assoc,2017,80(10):657-661.
[11]Lee SM,Park KH,Jung EY,et al.Frequency and clinical significance of short cervix in patients with preterm premature rupture of membranes[J].PLoS One,2017,12(3):e0174657.
[12]戴森戈,关飞云,张文淼,等.胎膜早破与生殖道感染的相关性探讨[J].中国计划生育学杂志,2016,24(1):46-49.
[13]Fouks Y,Many A,Orbach R,et al.Is there a role for placental cultures in cases of clinical chorioamnionitis complicating preterm premature rupture of membranes?[J].Am J Perinatol,2017,34(9):867-873.
[14]徐寒梅.胎膜早破对产妇产后感染及机体应激的影响[J].中国妇幼保健,2017,32(8):1641-1643.
[15]李小侠,解娟,詹颉,等.围产期胎膜早破与生殖道病原菌感染的分析[J].现代检验医学杂志,2016,31(4):90-92.