| ObjectiveTo compare the maternal and fetal outcomes of PPROM patients among different gestational age groups and different expectant time groups,and to investigate the influencing factors of expectant time of PPROM patients and their effect on the outcome of maternal and fetal outcomes,providing reference for good pregnancy outcome in patients with PPROM.Methods335 patients with PPROM who met the inclusion criteria and exclusion criteria were selected for hospitalization from January 1,2014 to December 31,2015.and medical records were retrospectively analyzed.According to the time of premature rupture of membranes,subjects were divided into three groups(group A,24~27+ 6 weeks of gestation;group B,28~31+ 6weeks of gestation;group C,32~33+ 6 weeks of gestation);Based on the time of expected treatment,subjects were also divided into three groups(group a,expected treatment time ? 2days;group b,expected treatment time> 2 days ~ ? 7 days;group c,expect treatment time> 7days).The maternal and neonatal outcomes of PPROM patients in different gestational weeks and expectant treatment groups were compared.Cox regression was used to analyze the factors influencing the expectation time of patients with PRROM <28 weeks.Results1.In the different gestational age group,the age,BMI,whether primipara,single twins,fetal position,gestational age,birth rate,previous cesarean section history,previous preterm birth history,previous adverse fertility history,pregnancy reproductive tract infection and other aspects of the difference,the differences were not statistically significant(P> 0.05).There was significant difference in the time of delivery and the expectation of treatment time(P<0.001).But there was no significant difference in the gestational age between the group A and group B(P> 0.05).2.Comparison of maternal outcomes in different gestational weeks of PPROM group:There were no significant differences in the body temperature,white blood cell count,CRP,Infection rate of Mycoplasma / Chlamydia / gram negative bacteria(P>0.05).The amniotic fluid Index comparison Group A > Group B > Group C,the difference was statistically significant(P<0.001).There was significant difference between group A and group B or group C(P<0.05).But there was no significant difference between group B and group C(P=0.636).There was significant difference of Palace mouth expansion between the three groups in the comparison between the two groups.There were significant differences in the length of cervical canal between group A and C.B,C group is also significant differences.The length of cervical canal in group A and B was not statistically significant(P=0.134).There was no significant difference in the mode of delivery between the three groups(P>0.05).Placental abruption,fetal distress,chorioamnionitis,postpartum hemorrhage,puerperal infection and postpartum placental pathology and other aspects of the difference,the difference was not statistically significant(P>0.05).3.Comparison of perinatal outcome of PPROM group in different gestational weeks: There was no significant difference between the three groups of PPROM patients in the incidence rate of less than gestational age(P>0.05).The average weight of neonates in group A and B was lower than that in group C,and neonatal NICU was longer than group C.Neonatal asphyxia rate,lung infection rate,respiratory distress syndrome(RDS),intraventricular hemorrhage(IVH),perinatal death and automatic discharge rate were higher than C group,the difference was statistically significant(P <0.05).There was no significant difference between group A and group B(P> 0.05).4.Effects of different expectations of treatment time on maternal outcome: There were no significant differences in age,BMI,gestational age,birth,whether primipara,single twins,fetal position,previous preterm birth history,previous cesarean section history,previous adverse fertility history and reproductive tract infection during pregnancy of Different expectations groups(P>0.05).There were no significant differences in the body temperature,white blood cell count,CRP,Infection rate of Mycoplasma / Chlamydia / gram negative bacteria(P>0.05).Rupture of membranes for weeks a group >b group >c group,cervical length and amniotic fluid index in a group <b group <c group admission,cervical dilatation in group >b group >c group,comparison between the three groups and the difference between the two were statistically significant(P <0.05).There were no significant differences in the incidence of maternal complications such as placental abruption,fetal distress,chorioamnionitis,postpartumhemorrhage and puerperal infection(P>0.05).With prolonged expectations,The average weight gain of newborns,stay in the NICU median time,rates of small for gestational age infants,neonatal asphyxia rate,lung infection rate,RDS,IVH,perinatal death and automatic discharge Gradually decreased,the difference was not statistically significant(P> 0.05).5.Factors affecting the duration of treatment of PPROM patients during pregnancy<28weeks : The incidence rate of placental abruption,chorioamnionitis,mycoplasma/chlamydia/gram negative bacteria was decreased with the prolongation of the gestational age.Comparison of neonatal outcomes,With the delivery of gestational age extension,neonatal weight gain,stay NICU time shortened,neonatal lung infection rate,RDS decreased,the difference was statistically significant(P<0.05);Neonatal asphyxia rate,perinatal death,IVH decreased,the difference was not statistically significant(P>0.05).Effects of gestational < 28 weeks in patients with PPROM expectant time factor: Cox regression analysis showed that rupture of membranes,gestational age,cervical length and admission of amniotic fluid index are the main factors affecting the expected treatment time(HRs were 7.33(95%CI: 2.31~23.51);0.97((95%CI:0.93~0.99);0.86(95%CI: 0.81~0.90,respectively).Conclusions1.Although the expectant treatment of varying lengths of time,there was no significant difference in the outcome of maternal pregnancy between patients with PPROM in different gestational weeks and did not increase the adverse outcome of perinatal children.2.The length of the expectation does not affect the outcome of the maternal outcome of PPROM patients.With the prolonged expectation,the average weight gain of neonates increased,the median time to stay NICU was shorter,less than the incidence of gestational age,neonatal asphyxia rate,lung infection rate,RDS,IVH,perinatal mortality and spontaneous discharge rate decreased.3.For pregnant women <28 weeks of PPROM,with the delivery of gestational age prolonged,maternal complications did not increase,neonatal weight gain,stay NICU time shortened,Neonatal asphyxia,pulmonary infection,RDS,IVH incidence and perinatal mortality were reduced.4.To take expectations of treatment for PPROM patients is feasible.Rupture of membranes,cervical canal length and admission amniotic fluid index are the main factors influencing theexpectation time.Comprehensive consideration of various factors,close monitoring of the situation of mother and child,timely termination of pregnancy,will be expected to get a good pregnancy outcome. |
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