Clinical Analysis Of IVF-ET Pregancies With Preterm Premature Rupture Of Membrane

Background:Infertility is increasing year by year.In 2016,WHO predicted that infertility would become the third largest disease in the world,which is an important medical and social problem.In vitro fertilization embryo transfer?IVF-ET?has solved the reproductive difficulties of a large number of infertile patients.But embryo implantation is still far from the endsuccessful delivery.Premature rupture of membranes is a common cause of premature delivery and is closely related to perinatal outcomes.IVF-ET fetus is very precious,if the occurrence of early rupture of membranes,clinical treatment is very difficult.Objective:The purpose of this study was to understand the clinical characteristics and related influencing factors of IVF-ET pregnant women with preterm premature rupture of membranes at different gestational weeks,so as to improve the understanding and provide better reference for IVF-ET pregnant women to achieve a better pregnancy outcome.Methods:This is a retrospective study.According to the inclusion and exclusion criteria,104 pregnant women with test-tube babies complicated with preterm premature rupture of the membranes from January 1,2017 to December 31,2017 were selected as the study subjects.According to different gestational weeks of membrane's rupture,59 cases were divided into group A?<24 weeks?,B?24-27⁺66 weeks?,C?28-31⁺66 weeks?,D(32-33⁺⁶weeks),and group E?34-36⁺66 weeks?.IVF-ET pregnant women complicated with PPROM were compared for influencing factors and pregnant outcomes at different gestational weeks,and risk factors of PPROM in IVF-ET pregnant women at 28 weeks were analyzed by logistic regression.Results:1.IVF-ET pregnant women occurred PPROM at 34-36⁺66 weeks the most,accounting for 56.7%,and accounted for 18.3%and 15.4%respectively at 32-33⁺66 weeks and 28-31⁺66 weeks.The incidence was less at24-27⁺66 weeks and less than 24 weeks,accounting for 4.8%respectively.2.Analysis of the inflammatory index at different gestational weeks.The smaller the gestational week of rupture,the higher the CRP value measured by IVF-ET at the time of admission.The mean CRP value of pregnant women at 34-36⁺66 weeks was 6.7±6.5,and that of pregnant women at<24 weeks was 31.0±33.5,with statistical difference?P<0.05?.3.There were statistically significant differences in perinatal mortality,expected treatment time,incidence of chorioamnionitis,NICU transfer rate,infectious diseases of newborn,neonatal hospitalization time,and neonatal expenses among the five groups.The perinatal mortality of PPROM at34-36⁺66 weeks and 32-33⁺66 weeks were 0,100%at<24 weeks.The expectant time of pregnant women with IVF-ET at 24-27⁺66 weeks was the longest,with an average of about 9.0±8.7 days,and the incidence of chorionic amnionitis was also the highest,40%.The expectant time at34-36⁺66 weeks and 32-33⁺66 weeks was shorter,only 0.6±1.6 days and2.4±2.6 days respectively.66.1%of newborns in the 34-36⁺66 weeks of gestation need to be transferred to NICU,and all neonates in other weeks of gestation need to be transferred to NICU for auxiliary support except the death cases.The incidence of neonatal infectious diseases and neonatal jaundice at 32-33⁺66 weeks were the highest?73.7%and 89.5%,respectively?,and the incidence of neonatal NRDS at 24-27⁺66 weeks was the highest?89.5%?.The younger the gestational age was,the longer the hospitalization days of the NICU were,and the higher the cost was.The median hospital time of the newborn at 24-27⁺66 weeks of gestation were 66days,and the median treatment cost was 100,000 yuan.The median time of hospital in neonatal NICU at 34-36⁺66 weeks were 7 days,and the median cost of treatment was 88,000 yuan.4.IVF-ET multiple pregnant women with PPROM neonatal outcome analysis.The NICU transfer rate,neonatal infectious disease,NRDS,neonatal jaundice composition ratio were 98.6%,41.1%,32.9%and 75.3%,respectively,which were significantly higher than those of neonates with intact membranes.5.Logistic regression analysis showed that cervical abnormality was an independent risk factor for premature rupture of membranes in IVF-ET pregnant women<28 weeks?OR=0.198,95%ci:0.042-0.941,P<0.05?.Conclusion:IVF-ET pregnant women with preterm premature rupture of membranes were more common at 34-36⁺66 weeks?56.7%?,but 9.6%occurred before 28 weeks,the neonatal outcome was poor,and cervical abnormality was an independent risk factor for preterm premature rupture of membranes before 28 weeks of pregnancy of IVF-ET pregnant women,which should be attached great importance.