Hnat Michael D, Mercer Brian M, Thurnau Gary, Goldenberg Robert, Thom Elizabeth A, Meis Paul J, Moawad Atef H, Iams Jay D, Van Dorsten J Peter
Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX 75390-9032, USA.
Am J Obstet Gynecol. 2005 Jul;193(1):164-8. doi: 10.1016/j.ajog.2004.10.625.
The purpose of this study was to compare perinatal outcomes among women with conservatively treated preterm premature rupture of membranes at 24 to 32 weeks of gestation in the presence or absence of vaginal bleeding.
This is a secondary analysis of 581 women with and without vaginal bleeding within 1 week of admission with preterm premature rupture of membranes at 24 to 32 weeks of gestation who were enrolled in a multicenter trial of antibiotic therapy during conservative treatment. The main outcome was latency to delivery. Other outcome variables included clinical abruptio placentae, amnionitis, perinatal death, severe intraventricular hemorrhage, and respiratory distress syndrome.
Outcome data were available for 581 patients (n=50 with bleeding). Latency to delivery was not affected by the presence or absence of bleeding. In general, a history of bleeding was associated with higher frequencies of subsequently diagnosed abruptio placentae (12% vs 3.5%; P=.01), perinatal death (16% vs 4.9%; P=.006), intraventricular hemorrhage (14.3% vs 5.9%; P=.03), and respiratory distress syndrome (69.4% vs 40.4%; P<.0001), when compared with those women with nonbleeding events. Women with bleeding were less likely to be black (42% vs 60%; P=.002) and had a lower mean gestational age at preterm premature rupture of membranes (27.6 vs 28.5 weeks; P=.02) when compared with white, Hispanic, and other. After an adjustment of data was made for potentially confounding factors, women with recent bleeding were more likely to be diagnosed with abruptio placentae at delivery (odds ratio, 2.8; 95% CI, 1.03-7.8; P=.04), and their infants were more likely to have respiratory distress syndrome (odds ratio, 3.1; 95% CI, 1.5-6.6; P=.004).
Vaginal bleeding before preterm premature rupture of membranes is associated with increased rates of neonatal respiratory distress syndrome and abruptio placentae, but not with reduced latency to delivery.
本研究旨在比较妊娠24至32周胎膜早破经保守治疗的孕妇在有或无阴道出血情况下的围产期结局。
这是一项对581例妊娠24至32周胎膜早破入院1周内有或无阴道出血的孕妇进行的二次分析，这些孕妇参加了保守治疗期间抗生素治疗的多中心试验。主要结局是分娩潜伏期。其他结局变量包括临床胎盘早剥、羊膜炎、围产期死亡、重度脑室内出血和呼吸窘迫综合征。
581例患者（n = 50例有出血）有结局数据。分娩潜伏期不受出血与否的影响。总体而言，与无出血事件的女性相比，有出血史的女性随后诊断为胎盘早剥（12%对3.5%；P = 0.01）、围产期死亡（16%对4.9%；P = 0.006）、脑室内出血（14.3%对5.9%；P = 0.03）和呼吸窘迫综合征（69.4%对40.4%；P < 0.0001）的频率更高。与白人、西班牙裔和其他种族相比，有出血的女性黑人比例较低（42%对60%；P = 0.002），胎膜早破时的平均孕周较低（27.6周对28.5周；P = 0.02）。在对潜在混杂因素进行数据调整后，近期有出血的女性在分娩时更有可能被诊断为胎盘早剥（优势比，2.8；95%可信区间，1.03 - 7.8；P = 0.04），其婴儿更有可能患呼吸窘迫综合征（优势比，3.1；95%可信区间，1.5 - 6.6；P = 0.004）。
胎膜早破前的阴道出血与新生儿呼吸窘迫综合征和胎盘早剥发生率增加有关，但与分娩潜伏期缩短无关。
