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目的:了解未足月胎膜早破(PPROM)孕妇生殖道感染状况,并观察不同孕周、不同潜伏期对母婴结局的影响及临床意义。方法:收集孕28~36+6周单胎头位PPROM孕妇120例,其中孕28~33+6周组60例,孕34~36+6周组60例,取两组孕妇宫颈分泌物进行支原体、衣原体检查及细菌培养,对无临床感染征象者采用保守治疗延长孕周,对于胎儿已成熟、有宫内感染或胎儿宫内窘迫者终止妊娠,比较两组阴道分泌物异常率及潜伏期对母婴结局的影响。结果:孕28~33+6周组孕妇病原体阳性率61.67%(37/60)明显高于孕34~36+6周组孕妇病原体阳性率38.33%(23/60),差异有统计学意义(P<0.05)。两组中主要病原体为革兰氏阳性菌(G+)、支原体、假丝酵母菌及混合感染,且孕周越小混合感染比例越大;孕28~33+6周组绒毛膜羊膜炎、新生儿感染、新生儿呼吸窘迫综合征(ARDS)及死亡率均明显高于孕34~36+6周组,差异有统计学意义(P<0.05);孕28~33+6周组潜伏期在48 h以内的胎儿宫内窘迫、ARDS发生率及死亡率均明显高于潜伏期在48 h以上的发生率,差异有统计学意义(P<0.05);孕34~36+6周组潜伏期长短对相关并发症发生率影响差异无统计学意义(P>0.05)。结论:胎膜早破与生殖道上行感染关系密切,可导致不良妊娠结局,在保守治疗延长孕周的同时需综合判定感染征象适时终止妊娠,可改善母婴结局。
Objective: To understand the status of reproductive tract infection in premature rupture of membranes of premature rupture of membranes (PPROM) and to observe the effect of different gestational age and different incubation period on maternal and infant outcomes and its clinical significance. Methods: 120 pregnant women with single fetal head position from 28 to 36 + 6 weeks of gestation were collected, of which 60 were pregnant from 28 to 33 + 6 weeks and 60 from 34 to 36 + 6 weeks pregnant. Cervical secretions from both groups were taken Mycoplasma, Chlamydia examination and bacterial culture, no signs of clinical signs of infection using conservative treatment to extend gestational age, for the fetus has matured, intrauterine infection or fetal distress termination of pregnancy, vaginal discharge than the two groups were abnormal rates and latency The impact of maternal and child outcomes. Results: The positive rate of pathogen in pregnant women from 28 to 33 + 6 weeks pregnant group was significantly higher than that of pregnant women (61.67%, 37/60) (38.33%, 23/60) P <0.05). The main pathogens in both groups were Gram-positive bacteria (G +), Mycoplasma, Candida and mixed infection, and the smaller the gestational age, the greater the proportion of mixed infection; pregnancy 28 ~ 33 + 6 weeks group chorioamnionitis, Children with respiratory tract infection, neonatal respiratory distress syndrome (ARDS) and mortality were significantly higher than those of pregnant 34-36 + 6-week group, the difference was statistically significant (P <0.05); pregnant 28-33 + 6 weeks group latency of 48 h, intrauterine fetal distress, ARDS incidence and mortality were significantly higher than the incubation period of more than 48 h incidence, the difference was statistically significant (P <0.05); pregnant 34 ~ 36 +6 weeks the incubation period of the length of the correlation There was no significant difference in the incidence of complications (P> 0.05). Conclusion: The premature rupture of membranes is closely related to ascending infection of the reproductive tract, which can lead to adverse pregnancy outcomes. It is necessary to comprehensively determine the signs of infection and timely termination of pregnancy when conservative treatment prolongs gestational age, which can improve the maternal and infant outcomes.