Mark S P, Croughan-Minihane M S, Kilpatrick S J
Departments of Obstetrics, Gynecology and Reproductive Sciences, Family and Community Medicine, Epidemiology and Biostatistics, and the School of Medicine, University of California, San Francisco, San Francisco, California, USA.
Obstet Gynecol. 2000 Jun;95(6 Pt 1):909-12. doi: 10.1016/s0029-7844(00)00816-4.
To clarify the relationships between intrapartum chorioamnionitis and abnormalities of uterine function, including labor abnormalities, cesarean delivery, and hemorrhage during parturition.
We did a retrospective cohort study on 16,226 deliveries between 1986 and 1996 that were identified from the University of California, San Francisco Perinatal Database. Variables included maternal age, parity, birth weight, gestational age, epidural usage, oxytocin usage, cesarean delivery, labor abnormalities, length of labor stages, estimated blood loss, and chorioamnionitis status. Analyses included chi(2), Student t test, and logistic regression.
In the chorioamnionitis group, there was a statistically significantly higher proportion of women with labor abnormalities (relative risks [RRs] 2.6-4.1), cesarean delivery (RR 3.3; 95% confidence interval [CI] 3.0, 3.5), hemorrhage after cesarean (RR 1.2; 95% CI 1.1, 1.3), and hemorrhage after vaginal delivery (RR 2.1; 95% CI 1.9, 2.4) compared with the nonchorioamnionitis group. Those findings stayed significant after multivariate analysis for various labor abnormalities (adjusted odds ratios [ORs] ranged 1.3-2.1), cesarean delivery (adjusted OR 1.8; 95% CI 1.5, 2.1), hemorrhage after cesarean (adjusted OR 1.5; 95% CI 1.2, 1.8), and hemorrhage after vaginal delivery (adjusted OR 1.8; 95% CI 1.5, 2.1).
Adverse associations between chorioamnionitis and labor abnormalities, cesarean rate, and hemorrhage during parturition appear to be significant, suggesting a deleterious effect of chorioamnionitis on uterine function.
明确产时绒毛膜羊膜炎与子宫功能异常之间的关系，包括产程异常、剖宫产及分娩期出血。
我们对1986年至1996年间从加利福尼亚大学旧金山分校围产期数据库中识别出的16226例分娩进行了一项回顾性队列研究。变量包括产妇年龄、产次、出生体重、孕周、硬膜外使用情况、缩宫素使用情况、剖宫产、产程异常、产程各阶段时长、估计失血量及绒毛膜羊膜炎状态。分析方法包括卡方检验、学生t检验及逻辑回归。
与非绒毛膜羊膜炎组相比，绒毛膜羊膜炎组中出现产程异常（相对风险[RRs]为2.6 - 4.1）、剖宫产（RR为3.3；95%置信区间[CI]为3.0, 3.5）、剖宫产后出血（RR为1.2；95% CI为1.1, 1.3）及阴道分娩后出血（RR为2.1；95% CI为1.9, 2.4）的女性比例在统计学上显著更高。在对各种产程异常（调整优势比[ORs]范围为1.3 - 2.1）、剖宫产（调整OR为1.8；95% CI为1.5, 2.1）、剖宫产后出血（调整OR为1.5；95% CI为1.2, 1.8）及阴道分娩后出血（调整OR为1.8；95% CI为1.5, 2.1）进行多因素分析后，这些结果仍然显著。
绒毛膜羊膜炎与产程异常、剖宫产率及分娩期出血之间的不良关联似乎很显著，提示绒毛膜羊膜炎对子宫功能有有害影响。
