胎膜早破383例临床分析

发布时间：2018-01-13 23:25

本文关键词：胎膜早破383例临床分析　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨不同孕龄胎膜早破终止妊娠时机、终止妊娠指征，合理选择终止妊娠方式，从而改善围生儿预后，综合考虑母儿因素，尽可能使母儿益处达到最大化。方法：回顾性分析383例胎膜早破患者的临床资料，并对其合理分组讨论和统计学处理。研究一：根据胎膜早破发生时孕周不同分组：A组：28-32周（64例），B组：32+1-34周（64例），C组：34+1-36周（104例），D组：＞36周（151例）。研究二：根据终止妊娠时孕周分组：I组：28-32周（49例），II组：32+1-34周（61例），III组：34+1-36周（107例），，IV组：＞36周（166例）。结果：研究一：1、383例PROM按胎膜早破发生时孕周不同分组，年龄、孕次比较差异无统计学意义（P＞0.05）。2、孕28-32周PROM的新生儿应用呼吸机、新生儿呼吸窘迫综合症、新生儿感染、颅内出血、死亡的发生率最高，差异有统计学意义（P＜0.05）。3、总体来看，随着期待治疗时间的延长，感染的发生率均增高。4、对于28+1-34周的PROM，适当给予期待治疗延长孕周，新生儿呼吸窘迫综合症的发生率显著降低。研究二：1、I组和II组终止妊娠主要是因为胎儿因素，分别占40.8%、39.3%。III组和IV组终止妊娠原因主要是临产，分别占42.1%、63.9%。2、随着终止妊娠的孕周增大，因临产而终止妊娠比率逐渐增加，而胎儿因素和母体因素逐渐降低。3、随着终止妊娠孕周增大，剖宫产率逐渐升高，阴道分娩率逐渐降低，IV组孕妇剖宫产率达71.7%、阴道分娩率低至28.3%。4、I组和II组剖宫产分娩可明显降低颅内出血发生率（P＜0.05）。III组和IV组在颅内出血方面剖宫产分娩和阴道分娩无统计学差异（P＞0.05）。各组内不同分娩方式对新生儿其他患病情况无统计学差异（P＞0.05）。结论：1、胎膜早破发生越早，新生儿预后越差，根据胎膜早破主要病因，孕期应给予积极有效的预防措施。2、对于妊娠小于32周的PROM，在严密监测孕妇和胎儿各项指标的情况下，可以采用期待疗法延长孕周至32周，以减少新生儿患病率和死亡率。3、32+1-34周的PROM如无感染征象，可适当延长孕周；如有感染可能，适时终止妊娠。4、大于34周的PROM，可不给予保胎治疗，可根据实际情况顺其自然等待产程发动或给予积极催产诱导其产程发动。5、对于胎膜早破终止妊娠方式的选择，目前研究不同终止妊娠方式对新生儿总体预后无显著差异，在临床工作中应根据实际情况、权衡利弊、充分沟通后个体化选择终止妊娠方式。
[Abstract]:Objective: to explore the timing of termination of pregnancy with premature rupture of membranes at different gestational ages, the indication of termination of pregnancy, and the reasonable choice of termination mode of pregnancy, so as to improve the prognosis of perinatal and to consider the factors of mother and infant. Maximize the benefits of motherhood as much as possible. Methods: the clinical data of 383 patients with premature rupture of membranes were analyzed retrospectively. Study 1: according to the gestational weeks of premature rupture of membranes, 64 cases of group B were divided into two groups: group A: 64 cases: group B: 32 ~ 34 weeks (n = 64). Group C (n = 104): > 36 weeks (n = 151). Study 2: according to the gestational week of termination of pregnancy, we divided into two groups: group I: 28-32 weeks and 49 cases: group II: 32-34 weeks and 61 cases; group III: 34-36 weeks (107 cases). Group IV: 166 cases were > 36 weeks old. Results: there were no significant differences in age and pregnancy in 383 cases of PROM according to the gestational weeks of premature rupture of membranes (P > 0. 05, P > 0. 05, P > 0. 05, P > 0. 05). Neonatal respiratory distress syndrome (RDS), neonatal infection, intracranial hemorrhage and the highest incidence of death were found in 28 to 32 weeks of gestation with PROM. The difference was statistically significant (P < 0.05). In general, with the prolongation of the expected treatment time, the incidence of infection increased by .4for PROM from 28 to 34 weeks. The incidence of neonatal respiratory distress syndrome was significantly reduced by appropriate expectant treatment for prolonged gestational weeks. In the study, the termination of pregnancy in group I and group II was mainly due to fetal factors, accounting for 40.8% 39.3.III and IV respectively. With the increase of gestational weeks, the ratio of termination of pregnancy due to labor gradually increased, while the fetal factors and maternal factors decreased gradually. With the increase of termination of pregnancy, the rate of cesarean section gradually increased, the rate of vaginal delivery decreased gradually, the rate of cesarean section in group IV was 71.7, and the rate of vaginal delivery was as low as 28.3.4. Caesarean delivery in group I and group II significantly reduced the incidence of intracranial hemorrhage (P < 0.05). There was no significant difference between caesarean delivery and vaginal delivery (P < 0.05). There was no significant difference between different delivery modes and other neonatal diseases in each group (P > 0.05). Conclusion: the earlier the premature rupture of membranes occurs, the worse the prognosis of newborns is. According to the main etiology of premature rupture of membranes, active and effective preventive measures should be taken during pregnancy, and PROM is less than 32 weeks of gestation. With closely monitored maternal and fetal indicators, expectant therapy can be used to extend the gestational age to 32 weeks in order to reduce neonatal morbidity and mortality. 32 to 34 weeks of PROM may extend gestational weeks if there are no signs of infection. If infection is possible, timely termination of pregnancy. 4, more than 34 weeks of Prom, can not be given fetal treatment, can be based on the actual situation waiting for the process of starting or giving active induction of labor induction of labor process launch .5. For the choice of termination of pregnancy with premature rupture of membranes, there is no significant difference in the overall prognosis of newborns in the study of different termination of pregnancy. In clinical work, we should weigh the advantages and disadvantages according to the actual situation. Individual choice of termination of pregnancy after full communication.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.433

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