胎膜早破孕妇的临床绒毛膜羊膜炎征象与组织学绒毛膜羊膜炎及新生儿结局的关系。

Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with premature rupture of membranes.

机构信息

Departments of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, P.M.B. 01129, Enugu State, Nigeria.

Departments of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla; P.M.B. 01129, 2Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu State, Nigeria.

出版信息

Niger J Clin Pract. 2023 Sep;26(9):1354-1360. doi: 10.4103/njcp.njcp_128_23.

DOI:10.4103/njcp.njcp_128_23

PMID:37794550

Abstract

BACKGROUND

Premature rupture of membrane (PROM), especially when preterm or prolonged is associated with an increased risk of chorioamnionitis with its attendant feto-maternal complications.

AIM

The study was aimed to determine the association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with PROM.

MATERIALS AND METHODS

Eligible participants with clinical diagnosis of PROM at gestational age of ≥28 weeks managed between December 2018 and June 2019 were consecutively recruited. Their sociodemographic characteristics, obstetrics history, and evidence of clinical chorioamnionitis using the Gibb's criteria were obtained. Following delivery, chorioamnionitis was histologically confirmed. Primary outcome measure was the proportion of women with PROM and histological chorioamnionitis that were detected clinically.

RESULTS

Of the 136 participants analyzed, 108 (79.4%) had term PROM, while 28 (20.6%) had preterm PROM (<37 weeks). The prevalence of histological chorioamnionitis was 50.0% compared to 16.2% using clinical indicators of infection. Histological chorioamnionitis was almost two times higher in preterm than term PROM (71.4% vs 38.9%). About two-third (67.6%) of the chorioamnionitis identified histologically were missed using clinical signs of chorioamnionitis. Clinical signs of chorioamnionitis had specificity of 100.0%, but low sensitivity (35.5%) and accuracy of 70.6%. A combination of three symptoms, maternal pyrexia and tachycardia, and fetal tachycardia appears to be the most reliable clinical indicator of chorioamnionitis in women with preterm PROM. There was a significant association between low birth weight, low Apgar score, NICU admission, and the presence of histological chorioamnionitis in women that had PROM.

CONCLUSION

Clinical signs of chorioamnionitis have a low sensitivity and are not very accuracy in diagnosing chorioamnionitis in women with PROM.

摘要

背景

胎膜早破（PROM），尤其是早产或延长时，与绒毛膜羊膜炎的风险增加及其伴随的胎儿-母体并发症相关。

目的

本研究旨在确定胎膜早破患者的临床绒毛膜羊膜炎征象与组织学绒毛膜羊膜炎及新生儿结局的关系。

材料和方法

连续招募了 2018 年 12 月至 2019 年 6 月期间在妊娠 28 周以上被临床诊断为胎膜早破的符合条件的参与者。记录了他们的社会人口统计学特征、产科病史以及使用 Gibb 标准获得的临床绒毛膜羊膜炎证据。分娩后，组织学证实有绒毛膜羊膜炎。主要观察指标为临床上检测到胎膜早破和组织学绒毛膜羊膜炎的妇女的比例。

结果

在 136 名分析的参与者中，108 名（79.4%）为足月胎膜早破，28 名（20.6%）为早产胎膜早破（<37 周）。与感染的临床指标相比，组织学绒毛膜羊膜炎的患病率为 50.0%。早产胎膜早破的组织学绒毛膜羊膜炎发生率几乎是足月胎膜早破的两倍（71.4% vs 38.9%）。约三分之二（67.6%）的绒毛膜羊膜炎通过临床绒毛膜羊膜炎征象漏诊。临床绒毛膜羊膜炎征象的特异性为 100.0%，但敏感性（35.5%）和准确性（70.6%）较低。在有早产胎膜早破的妇女中，母亲发热和心动过速以及胎儿心动过速这三种症状的组合似乎是绒毛膜羊膜炎最可靠的临床指标。胎膜早破妇女的低出生体重、低 Apgar 评分、NICU 入院和组织学绒毛膜羊膜炎之间存在显著关联。