| Objective: To investigate the cause of premature rupture of membranes and analyse its influence on pregnancy outcome. Analyse the relationship between premature rupture of membranes and infection, and analyze the common bacterial flora.Methods: Taken perinatal premature rupture of membranes of 1067 cases between 2013 October to 2015 October and reviewed the clinical data. Analysis the sign of the difference in patients with cesarean section rate and cesarean section indications between premature rupture of membranes and preterm premature rupture of membranes.At the same time,compared the incidence of fetal distress and the different occurrence of neonatal asphyxia between the twe groups; for the mother, compared with postpartum hemorrhage in the twe groups. In our hospital, from October 2013 to October 2015 delivery in patients with premature rupture of membranes with the following conditions has 943 cases.First, newborn and placenta secretion swabs of premature rupture of fetal membranes postpartum neonatal disease patients were taken as bacterial culture and identification. Second, part of the placental tissue specimens was taken as pathological examination. At the same time,taken patients without the occurrence of premature rupture of membranes with partial placenta pathology including 20 cases of premature delivery, 20 cases of full-term delivery patients. Compared PPROM patients, incidence of infection and bacterial flora with preterm premature rupture of membranes.Analyse of the follow three groups of infection difference:patients with premature rupture of membranes and without membrane rupture, between full-term and premature ruptureof membrane, between PPROM and preterm birth.Results: 1.In our hospital, the incidence of PROM was 15.3% and PPROM incidence rate was 6.3%. The incidence of preterm birth was 15.3%, PPROM accounted for preterm delivery ratio of 41.5%. 2.In patients with premature rupture of membranes, the cesarean section rate was 30.6%.Among the signs of cesarean section, dystocia caused by pelvic abnormalities, relative cephalopelvic disproportion, fetal abnormalities, abnormal labor was the most common sign, followed by fetal distress. The cesarean section rate of PPROM was 37%, the most common indications for cesarean section was fetal abnormalities. For the rate of cesarean section,preterm premature rupture of membranes was higher than that of preterm premature rupture of membranes, the difference was statistically significant. 3.The patients delivery in our hospital with fetal distress occurred was 22.3% and for the premature rupture of membranes part,the rate of fetal distress was 26.7% (preterm premature rupture of membranes in patients with fetal distress incidence rate was 27.5%, the rate of fetal distress with PPROM was 24.9%). Patients with premature rupture of membranes has higher incidence of fetal distress, the difference was statistically significant. 4.The patients with premature rupture of membranes of neonatal score: in preterm premature rupture of membranes patients with mild neonatal asphyxia rate was 4.1%, PPROM with neonatal asphyxia incidence was 12.5%(the incidence of mild asphyxia was 10%, severe asphyxia rate was 2.5%). Compared between PPROM and PROM, the PPROM has higner risk of neonatal asphyxia, the difference was statistically significant. 5.In our hospital,patients with postpartum hemorrhage occurred 2.4% and patients with premature rupture of membranes has the incidence of postpartum hemorrhage of 2.7%(preterm premature rupture of membranes of patients with postpartum hemorrhage occurred in 2.65% and PPROM patients the incidence of postpartum hemorrhage was 2.87%). In patients with premature rupture of membranes, the occurrence of postpartum hemorrhage rate was higher, but the difference was not statistically significant. 6.In our hospital, the incidence rate of patients with premature rupture of membranes that placental pathological return indicate chorioamnionitis was 61.7%( the chorioamnionitis in patients with preterm premature rupture of membranes occurred was 58.1% and PPROM patients with the incidence of chorioamnionitis was 69.4%). The probability of chorioamnionitis in PPROM patients is higher than patients with PROM, the difference was statistically significant.7.From postpartum neonatal throat swab and placenta secretion and identification of bacterial culture, in patients with PPROM,cultivate bacterial growth has incidence rate of 15.9%, and the incidence of PROM rate was 7.8%.Among these bacterial flora, Escherichia coli and Staphylococcus aureus are the most common ones. 8.Patients without the occurrence of premature rupture of membranes, placental biopsy results indicated for the rate of infection is 30%( the infection rate of infection in full-term is 35%,and the incidence rate of infection in premature delivery is 25%). Between patients with premature rupture of membranes and patients without membrane rupture, between full-term and premature rupture of membrane, between PPROM and preterm birth, compared the three groups of infection difference, PROM patients with chorioamnionitis suggested that the existence of infection has a higher rate incidence, the difference was statistically significant.Conclusion: Premature rupture of membranes easily leads to premature delivery, and PROM is the primary factor of late spontaneous preterm birth. The cesarean section rate is higher in patients with premature rupture of membranes, mainly caused by the fetal distress and relative cephalopelvic disproportion. Fetal distress and postpartum hemorrhage incidence was higher in patients with PROM. Compaired with PROM, the occurrence of neonatal asphyxia may be higher in PPROM patients. Therefore, in view of the disease of maternal and fetal harm, clinical attention should be paid to the disease, reduce the incidence, so as to reduce its harm to mother and fetus. Taking a full attention to the disease can reduce the incidence of PROM, and then reduce the harm to mother and infant.Inflammation is the important mechanism of PROM and may result in poor outcomes such as broncho-pulmonary dysplasia, early-onset sepsis, and neonatal morality in preterm infants. Because of its high incidence and with the increase of the membrane rupture time, the probability of infection increases. Therefore, it is very important to predict and control the infection in the early stage of the microbial causing of premature rupture of membranes. Therefore, premature rupture of membranes should take prophylactic antibiotics. In clinical work,it is important to strengthen perinatal health education and guidance, strengthen management of pregnancy and reduce the incidence of PROM, to improve the perinatal period quality. |
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