Clinical Investigation On Preterm Premature Of Membrane And Maternal-Fetal Prognosis

Objective: To determine the relationship between PPROM and pregnangcy outcome and maternal-fetal prognosis.Methods: 168 PPROM patients of pregnancy between 28-36⁺⁶ weeks who were hospitalized in the Obstetric Department of the first affiliated hospital guangxi medical university from January 2006 to October 2010 were collected and a retrospecctive analysis had been done. Patients were devided into two groups according to the gestational age: group A incluses 38 patients of pregnancy between 28-33+6 weeks, group B incluses 130 patients of pregnancy between 34-36⁺⁶ weeks. The control group incluces 220 patients of normal term pregnancy selected randomly during the same period, excluding patients of fetal death in the third trimester, fetal malformation, family planning abortion and pregnancy with chronic diseases. We analyze the causes for premature rupture of membrane in the observation group, time of tocolysis,neonatal outcome, the relationship between gestational age and neonatal morbidity, the impact of maternal, delivery mode and Pregnancy termination timing.Results: The differences of patient's age,primiparity and multiparity, postpartum hemorrhage among the three groups were not significant(P>0.05). 54.17% of PPROM cases may be accompanied with high risk factors, infections (Ureaplasma urealyticum (UU) or (and) Chlamydia trachomatis (CT), Candida bacterial vaginitis (VVC), syphilis etc.) accounted for a larger proportion of 18.45%. The difference of the mode of delivery between the groups was statistically significant(P<0.05); the rates of cesarean section, vaginal delivery and assisted vaginal delivery were different. the rate of cesarean section was highest in the group B; The different grades of neonatal asphyxi(mild asphyxia, severe asphyxia), neonatal respiratory distress syndrome (NRDS), neonatal pneumonia (NIP), neonatal hypoxic ischemic encephalopathy (HIE) and the frequency of automatic discharge or death were statistically significant (P<0.05), these were higher in group A than in group B; The difference of Infection of amniotic cavity and puerperal were statistically significant (P<0.05), and group A had the highest rate. In the observation group, the difference of postpartum hemorrhage, infection of amniotic cavity, chorioamnionitis, puerperal morbidity and NIP were statistically significant in the two subgroups(the period from rupture of the membrane to delivery≥48h and <48h) (P<0.05), the former is higher than the latter. The incidence of postpartum hemorrhage in PPROM prenatal infected group is higher than in the prenatal uninfected group But the rates of NRDS, neonatal HIE and automatic discharge or death had no significant difference (P>0.05), also that may be due to insufficient sample size in this study, expanding the sample size is needed to confirm that .Conclusion: 1.To actively prevent the occurrence of PPROM and strengthe- n perinatal care is one of the important measurement to reduce premature birth, neonatal morbidity, mortality and improve pregnancy outcomes.2 Postpartum hemorrhage, chorioamnionitis, infection of amniotic cavity and rate of puerperal infection increase, when PPROM occures. Postpartum hemorrhage, puerperal morbidity in PPROM prenatal infected group was higher than in pre-uninfected group.3.The longer of rupture of membranes to delivery is, the more risk of maternal infection increases.4. The morbidity of PPROM preterm children (NIP, HIE, NRDS) and automatic discharge or death all increase.