孕23至27周有或无胎膜早破的早产新生儿结局

Neonatal outcome in preterm deliveries between 23 and 27 weeks' gestation with and without preterm premature rupture of membranes.

作者信息

Newman Dana E, Paamoni-Keren Orit, Press Fernanda, Wiznitzer Arnon, Mazor Moshe, Sheiner Eyal

机构信息

Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva, Israel.

出版信息

Arch Gynecol Obstet. 2009 Jul;280(1):7-11. doi: 10.1007/s00404-008-0836-8. Epub 2008 Nov 25.

DOI:10.1007/s00404-008-0836-8

PMID:19031080

Abstract

OBJECTIVES

To characterize neonatal morbidity and mortality rates in extreme preterm deliveries (between 23 and 27 weeks' gestation) with and without PPROM, and to evaluate the association between PPROM and chorioamnionitis.

METHODS

A retrospective population-based study was conducted on preterm singleton pregnancies delivered between 23 and 27 weeks' gestation from 1988 to 2007. Immediate neonatal morbidity and mortality rates in pregnancies complicated by PPROM were compared to pregnancies with intact membranes. A multivariate analysis was conducted in order to determine the independent association between PPROM and chorioamnionitis.

RESULTS

Out of 1,437 preterm deliveries, 236 (16.4%) were complicated with PPROM. There were more neonates with low 1 min (61.0 vs. 42.5%; P = 0.001) and low 5 min (30.1 vs. 23.8%; P = 0.042) Apgar scores (of less than 7) in pregnancies complicated by PPROM than in the comparison group. There were more cases of chorioamnionitis in the PPROM group born at 23-24 weeks' gestation (33.8 vs. 17.0%; P < 0.001), and in the PPROM group born at 25-27 weeks (42.0 vs. 15.5%; P < 0.001). In the group born at 23-24 weeks' gestation, there were more postpartum deaths (PPD) in the PPROM group (70.0 vs. 54.8%; P = 0.013); however, there was no significant difference in PPD in the groups born at 25-27 weeks. In the group born at 23-24 weeks, as well as at 25-27 weeks, there were fewer antepartum deaths (APD) in the PPROM group as compared to the control group (16.3 vs. 32.6%; P = 0.002, and 5.3 vs. 36.3%; P < 0.001; respectively). After adjusting for gestational age and gender, using a multivariate analysis, the association between PPROM and chorioamnionitis remained significant (OR = 3.32; 95% CI 2.43-4.51, P < 0.001).

CONCLUSIONS

PPROM is associated with adverse perinatal outcome in deliveries between 23 and 27 weeks' gestation. Moreover, PPROM is an independent risk factor for chorioamnionitis.

摘要

目的

描述有无胎膜早破的极早早产（妊娠23至27周）新生儿的发病率和死亡率，并评估胎膜早破与绒毛膜羊膜炎之间的关联。

方法

对1988年至2007年妊娠23至27周分娩的单胎早产进行一项基于人群的回顾性研究。将合并胎膜早破妊娠的新生儿即时发病率和死亡率与胎膜完整的妊娠进行比较。进行多因素分析以确定胎膜早破与绒毛膜羊膜炎之间的独立关联。

结果

在1437例早产中，236例（16.4%）合并胎膜早破。与对照组相比，合并胎膜早破妊娠的新生儿1分钟Apgar评分低（61.0%对42.5%；P = 0.001）和5分钟Apgar评分低（30.1%对23.8%；P = 0.042）（低于7分）的情况更多。在妊娠23 - 24周出生的胎膜早破组中绒毛膜羊膜炎病例更多（33.8%对17.0%；P < 0.001），在妊娠25 - 27周出生的胎膜早破组中也是如此（42.0%对15.5%；P < 0.001）。在妊娠23 - 24周出生的组中，胎膜早破组产后死亡（PPD）更多（70.0%对54.8%；P = 0.013）；然而，在妊娠25 - 27周出生的组中PPD无显著差异。在妊娠23 - 24周以及25 - 27周出生的组中，与对照组相比，胎膜早破组产前死亡（APD）更少（分别为16.3%对32.6%；P = 0.002，以及5.3%对36.3%；P < 0.001）。在对孕周和性别进行校正后，通过多因素分析，胎膜早破与绒毛膜羊膜炎之间的关联仍然显著（OR = 3.32；95%CI为2.43 - 4.51，P < 0.001）。