摘要
目的 分析胎膜早破的危险因素及其对新生儿结局的影响,为胎膜早破新生儿是否需要提前干预提供临床依据.方法 采用便利抽样法选取2019年1月1日至12月31日北京市通州区妇幼保健院产科住院分娩的2 066例单胎产妇及其分娩的新生儿临床资料进行横断面研究,统计胎膜早破的发生率,分析胎膜早破的危险因素,分析胎膜早破对新生儿结局的影响,并进一步分析胎膜早破的时间和产前应用抗生素对新生儿结局的影响.结果 (1)2019年北京市通州区妇幼保健院产科单胎胎膜早破的发生率为28.94％(598/2 066).(2)多因素Logistic回归分析结果显示:孕周(足月)、剖宫产病史、漏斗骨盆、贫血、孕次、急性绒毛膜羊膜炎及巨大儿是胎膜早破的危险因素(P＜0.05).(3)根据胎膜在临产前是否发生自发性破裂分为胎膜早破组(n=598)和非胎膜早破组(n=1 468).胎膜早破组在早产和新生儿72 h内转新生儿科住院率分别为10.03％、10.20％,均高于非胎膜早破组(2.86％、7.29％),差异均有统计学意义(P＜0.05);胎膜早破组与非胎膜早破组的胎儿宫内窘迫、新生儿窒息和新生儿早期感染发生率比较,差异均无统计学意义(P＞0.05).(4)胎膜早破时间对新生儿出生后72 h内新生儿科住院预测的受试者工作特征(ROC)曲线中的切点为胎膜早破时间＞21 h,其预测新生儿出生后72 h内转新生儿科住院的曲线下面积为0.601,特异度为77.9％,灵敏度为37.7％.(5)胎膜早破＞21 h新生儿早期感染发生率、新生儿科住院发生率和产前抗生素使用率分别为7.04％、16.20％、94.37％,均高于胎膜早破≤21 h新生儿(2.63％、8.33％、35.96％),差异均有统计学意义(P＜0.05).结论 2019年北京市通州区妇幼保健院产科单胎胎膜早破的发生率为28.94％;剖宫产病史、漏斗骨盆、贫血、急性绒毛膜羊膜炎、孕次和巨大儿是胎膜早破的危险因素;胎膜早破增加了早产和新生儿科住院率,产前应用抗生素可降低新生儿早期感染发生率.
Abstract
Objective To analyze the risk factors of prelabor rupture of membranes and their effects on neonatal outcomes,so as to pro-vide clinical basis for whether premature intervention is needed in neonates with prelabor rupture of membranes.Methods The study was a cross-sectional study,convenience sampling method was used to select clinical data of 2 066 single pregnant women and their newborns who were hos-pitalized and delivered at the Department of Obstetrics and Gynecology,Tongzhou District Maternal and Child Health Hospital of Beijing from Janu-ary 1,to December 31,2019.The incidence of premature rupture of membranes was statistically analyzed,and the risk factors for premature rup-ture of membranes were analyzed,as well as their impact on neonatal outcomes.Furthermore,the timing of premature rupture of membranes and the impact of prenatal antibiotic use on neonatal outcomes were further analyzed.Results(1)The incidence of premature rupture of membranes in single pregnancies in Tongzhou District Maternal and Child Health Hospital of Beijing in 2019 was 28.94％(598/2 066).(2)Multivariate Lo-gistic regression analysis results showed that gestational age(term),history of cesarean section,funnel pelvis,anemia,number of pregnancies,a-cute chorioamnionitis,and macrosomia were risk factors for premature rupture of membranes.(3)According to whether the fetal membranes had spontaneous rupture before labor,they were divided into prelabor rupture of membranes group(n=598)and non-prelabor rupture of membranes group(n=1 468).The incidence of premature delivery and transferring to neonatal department within 72 hours on prelabor rupture of membranes group was 10.03％,10.20％,which were higher than those on non prelabor rupture of membranes group(2.86％,7.29％),the differences were statistically significant(P＜0.05),and there were no statistical differences between prelabor rupture of membranes group and non-prela-bor rupture of membranes group in the incidence of fetal distress,neonatal asphyxia and early neonatal infection(P＞0.05).(4)The cutoff point in the receiver operator characteristic(ROC)curve of prelabor rupture of membranes in predicting neonatal hospitalization within 72 hours af-ter birth is that the time of prelabor rupture of membranes is more than 21 hours.The area under the curve for predicting the transfer of newborns to neonatal hospitalization within 72 hours after birth was 0.601,with specificity of 77.9％and sensitivity of 37.7％.(5)The incidence of early infection,neonatal hospitalization,and prenatal antibiotic use in newborns with premature rupture of membranes＞21 hours were 7.04％,16.20％,and 94.37％,respectively,which were higher than those in newborns with premature rupture of membranes ≤21 hours(2.63％,8.33％,and 35.96％),and the differences were statistically significant(P＜0.05).Conclusion The incidence of premature rupture of membranes in sin-gle pregnancies in our hospital in 2019 was 28.94％;a history of caesarean section,funnel pelvis,anemia,acute chorioamnionitis,number of pregnancies,and macrosomia are risk factors for premature rupture of membranes prelabor rupture of membranes increases the incidence of preterm birth and neonatal hospitalization.Prenatal application of antibiotics can reduce the incidence of neonatal infection.
维普
万方数据