Yu Haiyan, Wang Xiaodong, Gao Haocheng, You Yong, Xing Aiyun
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University.
Biosci Trends. 2015 Feb;9(1):35-41. doi: 10.5582/bst.2014.01058.
Preterm premature rupture of the membranes (PPROM) remains the leading cause of preterm deliveries and neonatal mortality and morbidity. The current cohort study sought to retrospectively examine perinatal outcomes in cases of PPROM < 34 weeks' gestation that were managed conservatively from 2010 to 2012 and to identify risk factors for short-term neonatal outcomes. Subjects were 510 pregnancies consisting of 114 twin and 396 singleton pregnancies. Clinical chorioamnionitis occurred in 17.8% of the pregnancies. Neonatal mortality was 7.4%, the rate of major neonatal conditions was 40%, and the rate of NICU admission was 72.9%. The latency period exceeded 48 h in 62.5% of the pregnancies and 7 days in 24.3% of the pregnancies. Twin pregnancies had a shorter latency period than singleton pregnancies (median of 2 days versus 4 days, p < 0.001). Pregnancies complicated with early vaginal bleeding had a higher neonatal mortality (13.95% vs. 6.36%, p = 0.013) and morbidity (51.16% vs. 38.32%, p = 0.024), fewer weeks of gestation at PPROM (p = 0.029). Multivariate logistic regression analysis revealed that weeks of gestation at PPROM (OR: 0.953, 95% CI: 0.939-0.966, p < 0.001) and a latency period (OR: 0.948, 95%CI: 0.926-0.970, p < 0.001) were associated with neonatal mortality or morbidity. A twin pregnancy (OR: 0.319, 95% CI: 0.17-0.6, p < 0.001) and weeks of gestation at PPROM (OR: 0.737, 95% CI: 0.66-0.822, p < 0.001) were associated with the latency period. Gestational age at PPROM, a twin pregnancy, and the latency period are associated with neonatal mortality and morbidity.
早产胎膜早破（PPROM）仍然是早产以及新生儿死亡和发病的主要原因。本队列研究旨在回顾性分析2010年至2012年期间孕周＜34周的PPROM病例的围产期结局，并确定短期新生儿结局的危险因素。研究对象为510例妊娠，其中包括114例双胎妊娠和396例单胎妊娠。17.8%的妊娠发生了临床绒毛膜羊膜炎。新生儿死亡率为7.4%，主要新生儿疾病发生率为40%，新生儿重症监护病房（NICU）收治率为72.9%。62.5%的妊娠潜伏期超过48小时，24.3%的妊娠潜伏期超过7天。双胎妊娠的潜伏期比单胎妊娠短（中位数分别为2天和4天，p＜0.001）。合并早期阴道出血的妊娠新生儿死亡率（13.95%对6.36%，p = 0.013）和发病率（51.16%对38.32%，p = 0.024）更高，PPROM时的孕周更少（p = 0.029）。多因素logistic回归分析显示，PPROM时的孕周（比值比：0.953，95%置信区间：0.939 - 0.966，p＜0.001）和潜伏期（比值比：0.948，95%置信区间：0.926 - 0.970，p＜0.001）与新生儿死亡或发病相关。双胎妊娠（比值比：0.319，95%置信区间：0.17 - 0.6，p＜0.001）和PPROM时的孕周（比值比：0.737，95%置信区间：0.66 - 0.822，p＜0.001）与潜伏期相关。PPROM时的孕周、双胎妊娠和潜伏期与新生儿死亡和发病相关。
