胎膜早破孕妇围产期不良结局的决定因素：一项前瞻性队列研究。
Determinants for perinatal adverse outcomes among pregnant women with preterm premature rupture of membrane: A prospective cohort study.
作者信息
Abebe Tariku Abewa, Nima Dawit Desalegn, Mariye Yitbarek Fantahun, Leminie Abebaye Aragaw
机构信息
Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Medical Physiology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
出版信息
Front Reprod Health. 2022 Dec 15;4:1052827. doi: 10.3389/frph.2022.1052827. eCollection 2022.
BACKGROUND
One of the most critical functions of the fetal membranes is to remain intact until the onset of labor to maintain the protective intrauterine fluid environment. In most pregnancies, spontaneous rupture usually occurs near the end of the first stage of labor. Preterm premature membrane rupture (PROM) occurs when the fetal membrane ruptures before 37 weeks of pregnancy, and it contributes to adverse maternal, fetal, and neonatal outcomes. Therefore, this study aimed to determine the association of determinant factors with adverse perinatal outcomes.
METHODS
A prospective cohort study was conducted on pregnant women with preterm premature membrane rupture ( = 160) attending the teaching hospitals at Addis Ababa University. Socio-demographic and obstetric risk factors with adverse perinatal outcomes include the 5th minute Apgar score, neonatal intensive care unit (NICU) admission, early-onset neonatal sepsis (EONS), respiratory distress syndrome (RDS), perinatal mortality, Chorioamnionitis, and placental abruption were assessed. SPSS version 24, -test, test, and logistic regression analysis were used. -values <0.25 in the bivariate and < 0.05 in the multiple logistic regression were considered statistically significant.
RESULTS
The preterm (PROM) rate was 2.2% with perinatal mortality rate of 206/1,000. Gestational age (GA) at delivery was the determinate for low Apgar score at the 5th minute (AOR: 7.23; 95% CI, 1.10, 47.6; = 0.04). Unable to use steroid (AOR: 8.23; 95% CI, 1.83, 37.0; = 0.000), GA at membrane rupture (AOR: 4.61; 95% CI, 1.98, 31.8; = 0.000) and delivery (AOR: 4.32; 95% CI, 1.99, 30.9; = 0.000) were determinates for NICU admission. EONS was significantly affected by GA at membrane rupture (AOR: 5.9; 95% CI, 1.01, 37.0; = 0.04). Placental abruption was significantly affected by GA at delivery (AOR: 7.52; 95% CI, 1.15, 48.96; = 0.04).
CONCLUSION
GA at membrane rupture and delivery was the most critical predictors of adverse perinatal outcomes. Local guidelines on the approach and preterm PROM outcome management need to be prepared.
背景
胎膜最重要的功能之一是在分娩开始前保持完整，以维持子宫内的保护性液体环境。在大多数妊娠中，自然破裂通常发生在第一产程接近尾声时。早产胎膜早破（PROM）是指胎膜在妊娠37周前破裂，它会导致不良的母体、胎儿和新生儿结局。因此，本研究旨在确定决定因素与围产期不良结局之间的关联。
方法
对在亚的斯亚贝巴大学教学医院就诊的早产胎膜早破孕妇（n = 160）进行前瞻性队列研究。评估了与围产期不良结局相关的社会人口学和产科危险因素，包括第5分钟阿氏评分、新生儿重症监护病房（NICU）入院、早发型新生儿败血症（EONS）、呼吸窘迫综合征（RDS）、围产期死亡率、绒毛膜羊膜炎和胎盘早剥。使用SPSS 24版进行t检验、卡方检验和逻辑回归分析。双变量分析中p值<0.25且多因素逻辑回归中p<0.05被认为具有统计学意义。
结果
早产胎膜早破率为2.2%，围产期死亡率为206/1000。分娩时的孕周是第5分钟低阿氏评分的决定因素（调整后比值比[AOR]：7.23；95%置信区间[CI]，1.10，47.6；p = 0.04）。无法使用类固醇（AOR：8.23；95% CI，1.83，37.0；p = 0.000）、胎膜破裂时的孕周（AOR：4.61；95% CI，1.98，31.8；p = 0.000）和分娩时的孕周（AOR：4.32；95% CI，1.99，30.9；p = 0.000）是NICU入院的决定因素。胎膜破裂时的孕周对早发型新生儿败血症有显著影响（AOR：5.9；95% CI，1.01，37.0；p = 0.04）。分娩时的孕周对胎盘早剥有显著影响（AOR：7.52；95% CI，1.15，48.96；p = )
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