40例无生机的未足月胎膜早破成功治疗体会

发布时间：2018-04-29 13:25

本文选题：无生机的未足月胎膜早破 + 抗生素　；参考：《中国现代医学杂志》2017年25期

【摘要】：目的探讨成功保胎的40例23周无生机的未足月胎膜早破的治疗体会。方法选取2003年1月-2015年1月在该院就诊12~23周无生机未足月胎膜早破(PPROM)成功保胎者40例。入组患者均排除宫口已扩张、宫颈机能不全、子宫畸形、已明确诊断宫内感染者及继续妊娠危及母婴生命的严重并发症患者。明确诊断入组后予常规阴道病原微生物培养,根据药物敏感性选择抗生素治疗及宫缩抑制剂治疗,动态监测感染指标及B超宫内胎儿情况。结果 40例中33例均在2周内胎膜早破愈合,6例在4周内愈合,1例至孕36周未愈合。28~34周早产5例,34~36周早产9例,36周以后分娩者26例。羊水培养1例大肠杆菌阳性,胎盘病理检查有11例有不同程度中性粒细胞浸润。随访40例新生儿至今均无明显不良预后。结论无生机的未足月胎膜早破,须综合分析病情充分估计期待治疗或立即终止妊娠的利弊,患者充分知情理解选择下积极治疗,对部分无生机的早胎膜早破保胎治疗仍有一定可行性。
[Abstract]:Objective to explore the experience of treatment of premature rupture of unmatured membranes in 40 cases of successful fetal preservation for 23 weeks. Methods from January 2003 to January 2015, 40 cases of PPROM were treated in our hospital from January 2003 to January 2015. All the patients in the group were excluded from uterine dilatation, cervical insufficiency, uterine malformation, and confirmed diagnosis of intrauterine infection and serious complications of continuing pregnancy that endangered the life of mother and child. The patients were treated with routine vaginal microorganism culture, antibiotic therapy and uterine contraction inhibitor therapy were selected according to drug sensitivity, infection index and intrauterine fetal condition were monitored dynamically. Results among the 40 cases, 33 cases had premature rupture and healing of membranes within 2 weeks. 6 cases were healed within 4 weeks, 1 case was healed to 36 weeks of gestation, 5 cases were preterm labor, 9 cases were preterm delivery, 9 cases were after 36 weeks of labor. One case of Escherichia coli was positive in amniotic fluid culture, 11 cases had different degree of neutrophil infiltration in placenta pathological examination. Follow-up of 40 cases of newborns so far no significant adverse prognosis. Conclusion Non-term premature rupture of fetal membranes without vitality should be comprehensively analyzed and the advantages and disadvantages of expectant treatment or immediate termination of pregnancy should be fully estimated and the patients should be actively treated with full knowledge and understanding. It is still feasible to treat some lifeless premature rupture of membranes.
【作者单位】：浙江中医药大学附属广兴医院;
【分类号】：R714.433

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