The Effect Of Expectant Treatment On Maternal And Infant Outcomes In Preterm Premature Rupture Of Membranes

ObjectiveTo analyze the effect of PPROM in different pregnancy cycles on maternal and child outcomes in near-term(32～35⁺⁶ weeks),and to explore the feasibility of choosing a reas-onable treatment plan for PPROM patients in near-term(32～35⁺⁶ weeks)according to gest-ational age.Materials and MethodsRetrospective analysis of the near-term(32～35⁺⁶ weeks)of the Qianfoshan Hospital in Shandong Province from January 2015 to December 2018,with PPROM as the first dia-gnosis,and finally at 37 weeks.Clinical case data of pre-delivery patients.Exclusion crit-eria:（1）The rupture of the gestational week is not within the range of 32～35⁺⁶ weeks of pregnancy;（2）The history of childbirth in children with chromosomal diseases or the hist-ory of perinatal death for unknown causes;（3）Intrauterine infection is clearly present at admission.Fetal distress,death,abnormal fetal position,pelvic abnormalities,scar uterus,fetal malformation;（4）Multiple pregnancy;（5）Pregnancy complications and severe inter-nal surgery complications;（6）GBS positive;（7）Clinical case data imperfect.A total of 162 patients were eligible.The patients were divided into 32～33⁺⁶ weeks（group A）and 34～35⁺⁶ weeks（group B）according to different gestational weeks.According to whether or not the treatment is expected to be divided into 1,2 groups,respectively,the active intervene-tion group（actively admitted to the hospital and delivered within 48 hours）,and the expe-cted treatment group,a total of 4 groups（A1,A2,B1,B2）,Comparative analysis of sputum infection rate,chorioamnionitis rate,neonatal infection rate,pneumonia rate,NRDS,as w-ell as neonatal weight and Apgar score in four groups.Results1.Comparison of general conditions of pregnant woman in four group:The general conditions of the four groups of patients,including age,weight,height,number of pregna-ncies,and number of deliveries,were statistically insignificant（P>0.05）.2.Comparison of maternal and child outcomes in the pregnancy 32～33⁺⁶ weeks positive intervention group and the pregnancy 32～33⁺⁶ weeks expectation treatment group:There was no insignificant difference in gestational weeks of rupture between positive intervention group and expectant treatment group（P>0.05）.There were a significant differ-ence in birth weight and Apgar scores between the two groups（P<0.05）.The birth weight of the active intervention group（2051.00±278.51g）was lower than that of the expectant treatment group（2394.67±444.07g）,the total score of the newborn Apgar score in the pos-itive intervention group（27.57±2.70 points）was lower than the total score of the newborn Apgar score in the expectant treatment group（28.73±1.66 points）.The puerperal infection rate（3.3%vs 11.1%）,the incidence of chorioamnionitis（13.3%vs 20.0%）,the incidence of neonatal infection（16.7%vs 17.8%）,and the incidence of neonatal pneumonia（10.0%vs 13.3%）,the incidence of NICH（10.0%vs 0.0%）,There was no significant difference in-between the two groups（P>0.05）.The incidence of NRDS in the other two groups was a statistically significant（P<0.05）.The incidence of neonatal respiratory distress syndrome in the active intervention group（26.7%）was higher than that in the expectant treatment group（6.7%）.3.Comparison of maternal and child outcomes in the pregnancy 34～35⁺⁶ weeks posi-tive intervention group and the pregnancy 34～35⁺⁶ weeks expectation treatment group:Th-ere was no significant difference in the gestational age,neonatal birth weight and Apgar score between the positive intervention group and the expectant treatment group at 34～35⁺⁶weeks（P>0.05）.There were no significant differences in maternal infection rate（0.0%vs8.1%）,intrauterine infection rate（4.0%vs 16.2%）and neonatal infection rate（8.0%to 13.5%）between the two groups（P>0.05）.The maternal infection rate,intrauterine infection rate and neonatal infection rate in the control group was lower than that in the study group.There was no statistically significant difference of the neonatal pneumonia rate（6.0%vs10.8%）and NRDS rate（8.0%vs 10.8%）in two groups（P>0.05）.4.Comparisons of delivery modes and neonatal conditions of PPROM patients at di-fferrent gestational weeks:The cesarean section rate（25.3%vs 12.6%）of PPROM patients at 32～33⁺⁶ weeks of gestation was significantly different from that in 34～35⁺⁶weeks of ge-station of PPROM（P<0.05）.Comparisons between the two groups showed that the cesar-ean section rate at 32～33⁺⁶ weeks of gestation was significantly higher than that of PPRO-M at 34～35⁺⁶ weeks of gestation.The PPROM patients at 32～33⁺⁶ weeks of gestation were33.16±0.57 weeks,and those of PPROM patients at 34～35⁺⁶ weeks of gestation were 34.95±0.47 weeks.There was a statistically difference in two groups（P<0.05）.At the same ti-me,the neonatal asphyxia rate in 32～33⁺⁶ weeks of gestation was statistically significant d-ifference from that in 34～35⁺⁶weeks of gestation（P<0.05）.The probability of neonatal asphyxia of PPROM at 32～33⁺⁶ weeks of gestation is higher than that at 34～35⁺⁶ weeks of gestation.There was no statistically difference in the neonatal respiratory distress syndro-me rate between 32～33⁺⁶ weeks of pregnancy and 34～35⁺⁶ weeks of PPROM final delivery（P>0.05）.Conclusion1.For premature rupture of membranes patients with gestational weeks<34 weeks,expectant treatment should be given first without any contraindications,and the gestational weeks should be prolonged as far as possible to ensure the outcome of newborns and pay attention to monitoring the occurrence of mother-child infection,to ensure the safety and feasibility for expectant treatment.2.For patients with gestational weeks≥34 weeks,PPROM patients are recommended to actively terminate the pregnancy,but due to the limited number of cases in this study,more case samples should be collected in the future to further study the accuracy of the conclusions.3.The gestational age of PPROM is smaller,the worse the prognosis of newborns,the higher the cesarean section rate,the more attention should be paid to prenatal care and pregnancy care.Early detection and early treatment,and ensure maternal and child safety.