Ladfors L, Tessin I, Mattsson L A, Eriksson M, Seeberg S, Fall O
Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg University, Sweden.
J Perinat Med. 1998;26(2):94-101. doi: 10.1515/jpme.1998.26.2.94.
One thousand three hundred eighty-five women with PROM (prelabor rupture of the membranes) participated in a prospective randomized study. Women with PROM were randomized to induction the following morning after PROM (early induction group) or induction two days later (late induction group). If contractions started within 2 hours after admission these women were included in the short latency group. All neonatal infections were classified as verified sepsis (positive culture) or clinical sepsis. The aim of the study was to compare the perinatal infectious outcome between the groups with different expectant managements in women with PROM and to study the association between demographic, intrapartum and postpartum variables and neonatal sepsis. In the short latency group one neonate had a proven sepsis while four neonates with proven sepsis were found in the early induction group. No proven sepsis was detected in the late induction group. Univariate analyses showed a significant association between clinical sepsis and: induction of labor (OR = 2.94, 95% CI 1.30-6.68), established labor 24.1-32 hours after ROM (OR = 5.89, 95% CI 1.68-20.63), established labor > 32 hours after ROM (OR = 4.59, 95% CI 1.52-13.87), time from ROM to delivery > 32 hours (OR = 5.07, 95% CI 1.40-18.39), cesarean section (OR = 11.03, 95% CI 4.10-29.68), chorioamnionitis before or during delivery (OR = 27.14, 95% CI 2.38-309.16), endometritis (OR = 18.08, 95% CI 1.82-179.87), CRP over 20 mg/l in the umbilical cord (OR = 17.12, 95% CI 5.68-52.12) and Apgar score < 7 after 1, 5 or 10 minutes. In a stepwise logistic regression analysis a significant association was found between clinical sepsis and cesarean section (OR = 10.08, 95% CI = 3.26-31.20), time from ROM to delivery > 32 h (OR = 3.74, 95% CI 1.62-8.62), gestational age 34-36 weeks (OR = 3.16, 95% CI 1.11-8.96) and parous women (OR = 2.41, 95% CI 1.04-5.57). In conclusion, this study indicates that that there was no difference in the incidence of neonatal infections between those with early and late induction. Clinical neonatal sepsis was associated with time from PROM to delivery over 32 hours, cesarean section, parous women and gestational age between 34 and 36 weeks.
1385名胎膜早破（PROM）的女性参与了一项前瞻性随机研究。胎膜早破的女性被随机分为胎膜早破后次日早晨引产（早期引产组）或两天后引产（晚期引产组）。如果入院后2小时内开始宫缩，这些女性被纳入短潜伏期组。所有新生儿感染分为确诊败血症（培养阳性）或临床败血症。本研究的目的是比较胎膜早破女性不同期待管理组之间的围产期感染结局，并研究人口统计学、产时和产后变量与新生儿败血症之间的关联。在短潜伏期组中，有1例新生儿确诊败血症，而早期引产组中有4例确诊败血症的新生儿。晚期引产组未检测到确诊败血症。单因素分析显示临床败血症与以下因素之间存在显著关联：引产（比值比[OR]=2.94，95%置信区间[CI]1.30 - 6.68）、胎膜破裂后24.1 - 32小时开始分娩（OR = 5.89，95% CI 1.68 - 20.63）、胎膜破裂后>32小时开始分娩（OR = 4.59，95% CI 1.52 - 13.87）、从胎膜破裂到分娩的时间>32小时（OR = 5.07，95% CI 1.40 - 18.39）、剖宫产（OR = 11.03，95% CI 4.10 - 29.68）、分娩前或分娩期间绒毛膜羊膜炎（OR = 27.14，95% CI 2.38 - 309.16）、子宫内膜炎（OR = 18.08，95% CI 1.82 - 179.87）、脐带血中C反应蛋白超过20mg/l（OR = 17.12，95% CI 5.68 - 52.12）以及1、5或10分钟后阿氏评分<7。在逐步逻辑回归分析中，发现临床败血症与剖宫产（OR = 10.08，95% CI = 3.26 - 31.20）、从胎膜破裂到分娩的时间>32小时（OR = 3.74，95% CI 1.62 - 8.62）、孕34 - 36周（OR = 3.16，95% CI 1.11 - 8.96）和经产妇（OR = 2.41，95% CI 1.04 - 5.57）之间存在显著关联。总之，本研究表明早期引产和晚期引产的新生儿感染发生率没有差异。临床新生儿败血症与从胎膜早破到分娩的时间超过32小时、剖宫产、经产妇以及孕34至36周有关。
