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目的探讨足月胎膜早破孕妇引产时机。方法对2014年9月1日-2015年9月30日在天津市红桥医院分娩的341例足月、单胎头位、无其他合并症的初产胎膜早破孕妇的临床资料进行回顾性分析。按照自然临产和缩宫素引产的不同时间分为4组:1组为自然破膜后<2 h自然临产的孕妇32例,2组为自然破膜后2~12 h自然临产的孕妇96例,3组为自然破膜后2 h未临产予静点缩宫素引产的孕妇93例,4组为自然破膜后12 h未临产予静点缩宫素引产的孕妇120例。分析各组孕妇分娩方式及母婴结局与破膜至分娩时间之间的关系。结果 341例胎膜早破孕妇中临床未干预128例,占38%,其中1组剖宫产率为9.4%,宫腔感染率为3.1%,产后出血率为3.1%,与2组剖宫产率为6.3%,宫腔感染率为7.3%,产后出血率为8.3%差异无统计学意义(P>0.05),2组新生儿病率为31.3%明显高于1组的3.1%,差异具有统计学意义(P<0.05)。破膜2 h及12h后行缩宫素引产者共213例,占62%,其中3组的破膜至分娩的平均时间为16.8 h,少于4组的破膜至分娩的平均时间24.6 h,差异具有统计学意义(P<0.05),3组的剖宫产率为21.5%,宫腔感染率3.2%,新生儿病率为22.6%,均低于4组的剖宫产率34.2%,宫腔感染率11.7%,新生儿病率38.3%,且差异均具有统计学意义(P<0.05),而产后出血2组发生率分别为5.4%与8.3%,差异无统计学意义(P>0.05)。结论胎膜早破孕妇破膜至分娩时间延长可增加剖宫产率,影响母儿结局,足月胎膜早破2 h后引产较12 h后引产可降低剖宫产率,减少母儿并发症。
Objective To investigate the timing of labor induction of full-term premature rupture of membranes in pregnant women. Methods The clinical data of 341 full-term pregnant women with single fetus head and no premature rupture of membranes in the Hongqiao Hospital of Tianjin from September 1, 2014 to September 30, 2015 were retrospectively reviewed Sexual analysis. According to the natural labor and oxytocin induction of different time is divided into four groups: one group of spontaneous rupture of membranes <2 h naturally pregnant women 32 cases, 2 groups of spontaneous rupture of membranes after 2 to 12 h naturally pregnant women 96 cases , Three groups of spontaneous rupture of the hind limb oxytocin at 2 hours after spontaneous rupture of 93 cases of pregnant women, 4 groups of spontaneous rupture of membranes 12 hours after unprotected intravenous oxytocin induced abortion of 120 pregnant women. The relationship between the mode of delivery and maternal and infant outcomes in each group and the time from rupture of membrane to delivery was analyzed. Results Among 341 pregnant women with premature rupture of membranes, 128 had no clinical intervention, accounting for 38% of them, of which cesarean section rate was 9.4% in group 1, 3.1% in uterine cavity infection and 3.1% in postpartum hemorrhage, The incidence of intrauterine infection was 7.3% and the rate of postpartum hemorrhage was 8.3% (P> 0.05). The neonatal morbidity was 31.3% in group 2, which was significantly higher than that in group 1 (3.1%). The difference was statistically significant Statistically significant (P <0.05). In 2 and 12 hours after rupture of membranes, 213 cases of oxytocin induced abortion were performed, accounting for 62%. The mean time from rupture of membranes to childbirth in 3 groups was 16.8 h, and the average time from rupture of membranes to delivery in 4 groups was 24.6 h , The difference was statistically significant (P <0.05), cesarean section rate was 21.5%, intrauterine infection rate 3.2%, neonatal rate was 22.6% in 3 groups, were lower than the 4 groups of cesarean section rate 34.2% , Intrauterine infection rate was 11.7%, newborn rate was 38.3%, and the difference was statistically significant (P <0.05), while the incidence of postpartum hemorrhage in two groups were 5.4% and 8.3%, the difference was not statistically significant (P > 0.05). Conclusion Premature rupture of membranes rupture of membranes to prolonged labor can increase the rate of cesarean section, affecting maternal and child outcomes, full-term premature rupture of membranes 2 h after induction of labor than 12 h after induction of labor can reduce cesarean section rate and reduce the mother and child complicated disease.