足月妊娠产时发热的危险因素及相关母婴后遗症
Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae.
作者信息
Burgess Angela P H, Katz Justin E, Moretti Michael, Lakhi Nisha
机构信息
Richmond University Medical Center, Department of Obstetrics and Gynecology, Valhalla, New York, USA.
出版信息
Gynecol Obstet Invest. 2017;82(5):508-516. doi: 10.1159/000453611. Epub 2017 Jan 20.
AIM
To determine factors associated with intrapartum fever and to examine associated maternal and neonatal outcomes.
METHODS
Retrospective study of patients between 360/7 and 420/7 gestational weeks who entered spontaneous or induced active labor and developed temperature ≥38°C; a similar group that did not develop fever were controls. Univariate and multivariate analyses were performed with p < 0.05 as significant.
RESULTS
Fifty-four febrile patients and 306 nonfebrile controls met inclusion criteria. Nulligravidity (45.8 vs. 77.8%, p < 0.001), length of first stage ≥720 min (OR 3.59, 95% CI 1.97-6.55, p < 0.001), length of second stage ≥120 min (OR 4.76, 95% CI 2.29-9.89, p < 0.001), membrane rupture ≥240 min (46.4 vs. 79.6%, p < 0.001), increasing number of vaginal exams (4 vs. 6, p < 0.001), oxytocin (44.8 vs. 63.0%, p = 0.014), and meperidine (14.7 vs. 35.2%, p < 0.001) were all associated with intrapartum fever. Associated morbidity included cesarean delivery (22.5 vs. 44.4%, p = 0.001), Apgar score <7 at 5 min (0.7 vs. 5.6%, p = 0.011), and neonatal intensive care unit admission (9.5 vs. 51.9%, p < 0.001).
CONCLUSION
We have identified several noninfectious factors that are associated with intrapartum fever. Modification of risk factors may improve both maternal and neonatal outcomes.
目的
确定与产时发热相关的因素，并检查相关的母婴结局。
方法
对妊娠36⁰/₇至42⁰/₇周进入自然分娩或引产活跃期且体温≥38°C的患者进行回顾性研究；选取未发热的类似组作为对照。进行单因素和多因素分析，以p<0.05为有统计学意义。
结果
54例发热患者和306例未发热对照符合纳入标准。初产妇（45.8%对77.8%，p<0.001）、第一产程时长≥720分钟（比值比3.59，95%可信区间1.97 - 6.55，p<0.001）、第二产程时长≥120分钟（比值比4.76，95%可信区间2.29 - 9.89，p<0.001）、胎膜破裂≥240分钟（46.4%对79.6%，p<0.001）、阴道检查次数增加（4次对6次，p<0.001）、缩宫素使用（44.8%对63.0%，p = 0.014）以及哌替啶使用（14.7%对35.2%，p<0.001）均与产时发热相关。相关并发症包括剖宫产（22.
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