Analysis Of Pregnancy Outcomes And Relative Factors On158Cases With Preterm Premature Rupture Of Membranes

Objective：To evaluate the relative factors, clinical treatment of different gestationalweeks and the effects of the time of membranes rupture on neonatal and maternaloutcomes with preterm premature rupture of membranes (PPROM). Research should beimproved in order to reduce the incidence of neonatal and maternal complications andmortality rate.Methods： A retrospectively analysis of158cases of PPROM in the Military GeneralHospital of Bei Jing PLA from January2009to December2012was made. Accordingto the gestational age (GA), all cases were divided into three groups: GA28～31+6(group A), GA32～33+6(group B), GA34～36+6(group C). Asked about medicalhistory, checked the gestational age, studied the possible inducement, delivery mode,neonatal and maternal outcomes.Results：1.General condition of PPROMThe differences of patient’s age, primiparity and multiparity among the threegroups had no statistical difference (P＞0.05).2. Relative factors of PPROM67.72%of cases were accompanied with relative factors, and the main factors werevaginitis induced abortion and fetal position abnormal, accounting for29.11%,22.15%and12.66%.3. Comparison of mode of delivery of PPROMThe difference of the mode of delivery in the groups was statistically significant (P＜0.05); the rates of cesarean section and natural delivery were different; but theincidence of assisted vaginal delivery was no significant difference(P＞0.05). The rateof cesarean section was highest in the group A. There were significant difference between the rates of vaginal delivery andcesarean section in rupture break duration＜24h group and≥24h group;but theincidence of assisted vaginal delivery was no difference(P＞0.05).With the ruptureduration, the incidence of cesarean section increased. The main indications for cesareansection were: fetal distress and oligohydramnios.4. Pregnancy outcomes of PPROMThe difference of intraamniotic infection, postpartum hemorrhage and puerperalmorbidity were statistically significant in two groups (＜24h and≥24h); but theincidence of placental abruption was not statistically significant (P＞0.05). Theincidence rate of intraamniotic infection, postpartum hemorrhage and puerperalmorbidity when the membranes ruptured over24hours was much higher than when itwas less than24hours.Statistical analysis of perinatal newborn, there were statistically significantdifference among the incidence of neonatal asphyxia, pneumonia, respiratory distresssyndrome(P＜0.05); but no statistical difference between the incidence of intracranialhemorrhage and the frequency of automatic discharge or death in GA28～31+6, GA32～33+6, and GA34～36+6(P＞0.05). There were statistical difference among theincidence of neonatal asphyxia, pneumonia, respiratory distress syndrome by comparegroup A and group B(P＜0.0167); the same as group A and group C(P＜0.0167); butno statistical difference by compare group B and group C(P＞0.0167). The smaller thegestational age is, the higher morbidity of neonatal asphyxia, pneumonia, respiratorydistress syndrome improve.Conclusion：1. To strengthen perinatal care and actively prevent the relative factors of PPROM isone of the important measures to reduce morbidity.2. How to choose the proper timing and mode of the delivery should be weighed inclinical treatment of PPROM.3. However, neonatal and maternal outcomes are closely related with the gestational ageand the rupture duration, the smaller the gestational age and the longer the ruptureduration, the poorer neonatal and maternal outcomes. When GA is shorter than34weeks, some measures should be taken to reduce neonatal complications, increased thesurvival rate and harvest more satisfactory pregnancy outcomes, including expecttreatment, the application of steroids, antibiotics, uterine contraction and so on.