沙特阿拉伯一家教学医院收治的孕妇胎膜早破的预测因素及结局：一项队列研究。
Predictors and outcomes of premature rupture of membranes among pregnant women admitted to a teaching Hospital in Saudi Arabia: a cohort study.
作者信息
Wahabi Hayfaa, Elmorshedy Hala, Bakhsh Hanadi, Ahmed Samia, AlSubki Raghad E, Aburasyin Amsha S, Fayed Amel, Mahmoud Ibrahim Goda Amal
机构信息
Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia.
Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
出版信息
BMC Pregnancy Childbirth. 2024 Dec 23;24(1):850. doi: 10.1186/s12884-024-07020-x.
BACKGROUND
Premature rupture of the membrane (PROM), refers to rupture of the fetal membranes prior to the onset of regular uterine contractions. When this occurs at term (≥ 37 weeks of gestation), it is classified as PROM, whereas if it occurs before 37 weeks, it is termed preterm premature rupture of membranes (PPROM). PROM and PPROM are linked to adverse outcomes for both mother and newborn.
OBJECTIVES
To investigate the factors associated with PROM and the outcomes of pregnancies complicated with PROM.
METHODS
This was a retrospective cohort study. The participants were divided into three groups; those with PROM, those with PPROM and a control group who had normal onset of membranes rupture. The groups were compared with respect to predictors of PROM (maternal demographic profile, obstetrical history, and comorbidities), in addition to outcomes (postpartum hemorrhage, hospital stay, low APGAR scores, sepsis, low birthweight, preterm rate, and admission to neonatal Intensive care Unit (NICU)). Multivariable logistic regression model was used for predicting risk factors associated with PROM and PPROM.
RESULTS
A total of 1,894 pregnant women were enrolled in the study, 77.6% had normal onset of ruptured membranes, while 382 (20.1%) were diagnosed with a PROM and 43 (2.3%) diagnosed with PPROM. Primiparous mothers were more likely to develop PROM (AOR = 1.56, 95% CI (1.10-2.22)) as compared to multiparous, while obese and overweight mothers were less likely to develop PPROM (AOR = 0.86, 95% CI (0.94 - 0.49)). Significantly more mothers with PPROM were delivered by emergency cesarean Sect. (30.2% vs. 22.9%, P < 0.01), develop chorioamnionitis (4.7% vs. 0.1%, P < 0.01), and stayed in the hospital more than three days (16.3% vs. 2.5%, P < 0.01) compared to the control group. Neonates of mothers who had PPROM were more likely to have low birth weight (35.7% vs. 10.4%, P < 0.01), and NICU admission (67.4% vs. 20.4%, P < 0.01) as compared to the control group. Perinatal death rate was not significantly different between the groups.
CONCLUSION
In this study, nulliparity is a predictor of PROM, while overweight/ obese mothers are less likely to develop PPROM. Despite the relatively low occurrence of PPROM among Saudi women, the condition is associate with increase risk of cesarean section delivery, chorioamnionitis, prolonged hospitalization, and an increase need for neonatal intensive care compare to those with a normal onset of membrane rupture.
背景
胎膜早破（PROM）是指在规律宫缩开始前胎膜破裂。若发生在足月时（妊娠≥37周），则分类为胎膜早破，而若发生在37周之前，则称为早产胎膜早破（PPROM）。胎膜早破和早产胎膜早破与母亲和新生儿的不良结局相关。
目的
研究与胎膜早破相关的因素以及合并胎膜早破的妊娠结局。
方法
这是一项回顾性队列研究。参与者被分为三组：胎膜早破组、早产胎膜早破组和胎膜正常破裂的对照组。除结局（产后出血、住院时间、阿氏评分低、败血症、低出生体重、早产率以及入住新生儿重症监护病房（NICU））外，还比较了三组胎膜早破的预测因素（母亲人口统计学特征、产科病史和合并症）。采用多变量逻辑回归模型预测与胎膜早破和早产胎膜早破相关的危险因素。
结果
本研究共纳入1894名孕妇，77.6%的孕妇胎膜正常破裂，382名（20.1%）被诊断为胎膜早破，43名（2.3%）被诊断为早产胎膜早破。与经产妇相比，初产妇更易发生胎膜早破（比值比[AOR]=1.56，95%可信区间[CI](1.10 - 2.22)），而肥胖和超重母亲发生早产胎膜早破的可能性较小（AOR = 0.86，95%CI(0.94 - 0.49)）。与对照组相比，早产胎膜早破组的母亲急诊剖宫产分娩的比例显著更高（30.2%对22.9%，P<0.01），发生绒毛膜羊膜炎的比例更高（4.7%对0.1%，P<0.01），住院超过三天的比例更高（16.3%对2.5%，P<0.01）。与对照组相比早产胎膜早破组母亲的新生儿出生体重低的可能性更大（35.7%对10.4%，P<0.01），入住新生儿重症监护病房的比例更高（67.4%对20.4%，P<0.01）。各组围产儿死亡率无显著差异。
结论
在本研究中，初产是胎膜早破的一个预测因素，而超重/肥胖母亲发生早产胎膜早破的可能性较小。尽管沙特女性中早产胎膜早破的发生率相对较低，但与胎膜正常破裂的女性相比，该情况与剖宫产分娩风险增加、绒毛膜羊膜炎、住院时间延长以及新生儿重症监护需求增加相关。
Zotero 插件