Clinical Investigation On 308 Cases Of Preterm Premature Rupture Of Membrane

Objective:To evaluate the effects of preterm premature rupture of membrane (PPROM) on neonatal and maternal outcomes.Method:A retrospectively analysis of 308 cases of PPROM in year 2007 was made.1.The underlying etiology of PPROM was investigated.2.According to the gestational age(GA),all cases were divided into two groups:GA 28-33⁺⁶(group A) and GA 34-36⁺⁶(group B).The rate of dystocia,neonatal asphyxia,infection,intracranial hemorrhage,mortality and puerperal morbidity were compared between different groups.3.All cases were stratified according to the duration of PPROM into three groups:＜18h,18-72h,and＞72h,and the incidence of neonatal infection,intracranial hemorrhage,mortality,dystocia and puerperal morbidity were compared.Results:1.52.3%of cases were accompanied with high risk factors,including 45.45%with repeated pregnancy,15.58%with vaginitis,14.61%with multiple-birth,12.99%with breech,and so on..2.Dystocia rate,neonate morbidity and mortality,and puerperal morbidity are higher in group A(GA 28-33⁺⁶) than in group B(GA 34-36⁺⁶).In group A,the longer the tocolysis time is,the less the incidence of neonatal RDS, intracranial hemorrhage and mortality,and the higher the neonatal infection rate is.In group B,neonatal infection rate also increased as the tocolysis time prolonged.There is no relationship between tocolysis time and neonatal mortality & intracranial hemorrhage rate.3.The dystocia rate in three groups(＜18h,18-72h,and＞72h) were not statistically significant(65.00%,62.70%,65.52%respectively,P＞0.05).However, puerperal morbidity increased with the duration of PPROM prolonged,with the rate of 6.67%,10.32%,19.35%respectively(P＜0.05).Conclusion:PPROM is usually accompanied with multi risk factors,including repeated pregnancy,vaginitis,multiple birth,breech,and so on.In PPROM,the dystocia rate,neonatal mortality and morbidity are negatively related with the gestational age. When GA is shorter than 34 weeks,tocolysis may decrease the incidence of intracranial hemorrhage rate,and tends to decrease the incidence of respiratory distress syndrome, but has limited effects on neonatal mortality,and increase the infection rate.When GA reaches up to 34 weeks,the neonatal and maternal outcomes improve obviously,but puerperal morbidity increase obviously,so there is no need to do tocolysis therapy.The delivery mode in PPROM is not related to PPROM itself,but depends on the clinical condition.