| ObjectiveThe relationship between clinical indexes,such as the number of leukocytes,the percentage of neutrophils,the original value of calcitonin,C-reactive protein,amniotic fluid index and premature rupture of membranes with intrauterine infection were explored.To achieve timely intervention,so as to reduce perinatal complications and improve maternal and infant outcomes.Methods1.A total of 155 cases of puerpera admitted to the obstetrics department of subei people's hospital from September 2017 to May 2018 were selected.Among them,35 cases complicated with PPROM,60 cases complicated with PROM,and the 60 cases of normal control group.Inclusion criteria:all pregnant women in this pregnancy were singleton head position,excluding hypertension,diabetes,autoimmune diseases,acute and chronic inflammatory diseases,infectious diseases and other medical and surgical complications.The clinical data were collected,including gestational age,maternal birth,body temperature,boay temperature before delivery,peripheral white blood cell count,neutrophil count,calcitonin,C-reactive protein,amniotic fluid index,Umbilical artery s/d,neonatal weight,Apgar score and so on.2.The number of leukocytes,percentage of neutrophils,procalcitonin,C-reactive protein and amniotic fluid index were analyzed with hematoxylin eosin staining.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and yoden index were compared,and the accuracy was analyzed under receiver operating characteristic curve.3.The data of pregnancy outcomes were collected,including cesarean section rate,postpartum hemorrhage,postpartum fever,neonatal pneumonia,neonatal sepsis,Neonatal myocardial damage,and perinatal mortality and so on.Results1.One-way ANOVA was used to analyze the general data between the three groups.The neonatal body weight in the pre-term premature rupture group was lower than that in the normal control group and the full-term premature rupture group,and the difference was statistically significant(P<0.05).There were no statistical significances in age,pregnancy,birth,BMI and Apgar score of neonates in the three groups(P>0.05).2.Pathological results of membrane tissue:there were 7 cases with intrauterine infection in the normal control group,the intrauterine infection rate was 11.67%(7/60),and 53 cases without intrauterine infection.In PROM group,34 cases were complicated with intrauterine infection,the intrauterine infection rate was 58.33%(34/60),and 26 cases without intrauterine infection.In PPROM group,there were 26 cases with intrauterine infection,the rate of intrauterine infection was 73.53%(26/35),and 9 cases without intrauterine infection.3.Result of the relationship between time interval of membranes ruptured to delivery and intrauterine infection:In 35 cases of PPROM,5 cases were less than 12 hours,8 cases were 12-24 hours,and 13 cases were more than 24 hours.In the group without intrauterine infection,there were 2 cases in less than 12 hours,2 cases in 12-24 hours and 5 cases in more than 24 hours.There was no significant difference in the rupture time between the two groups(=0.241,P=0.886).4.Using One-way ANOVA method analyze the general information between the three groups,including 30 cases in the normal control group,60 cases in PROM and 35 cases in PPROM.The number of leukocytes,percentage of neutrophils,procalcitonin,C-reactive protein and amniotic fluid index of the three groups were all statistically significant(P<0.01).There was no significant difference in body temperature(F=0.123,P=0.885)and umbilical artery S/D(F=0.054,P=0.947)5.With HE staining as the gold standard,155 cases were divided into two groups:intrauterine infection group and non intrauterine infection group5.1 comparison of diagnostic evaluation indexes of single indexWBC,NE%,PCT,CRP and AFI positive and negative cases were counted.Sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and Jordan index were analyzed.The highest sensitivity index was ne%(89.55%),and the highest specificity index was AFI(97.73%).The highest positive likelihood ratio was PCT(975.69%),the lowest negative likelihood ratio was ne%(0.46),and the highest Jordan index was PCT(0.70).The results of ROC curve analysis showed that the areas under WBC,NE,PCT and AFI curves were 0.774,0.804,0.825 and 0.829,respectively,which indicated that the four indexes had certain preparation for monitoring intrauterine infection,and the area under CRP curve was 0.938,indicating that the accuracy of monitoring intrauterine infection was more higher.5.2 comparison of diagnostic evaluation indexes of two indexesThe sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and Jordan index of WBC,NE%,PCT,CRP and AFI were analyzed.Among them,WBC+ ne(74.63%)and PCT+CRP(74.63%)were the most sensitive indicators,PCT+AFI(98.86%)was the highest specificity indicator,PCT+AFI(4595.36%)was the highest positive likelihood ratio,PCT+CRP(27.23%)was the lowest negative likelihood ratio,and PCT+CRP(0.68)was the highest Jordan index.The results of ROC curve analysis showed that the areas under WBC+ne%,WBC+PCT,WBC+AFI,NE%+PCT and PCT+AFI curves were 0.804,0.832,0.867,0.862 and 0.857,respectively,which suggested that the five combined indexes had certain preparation for monitoring intrauterine infection.The areas under WBC+CRP,NE%+CRP,NE%+AFI,PCT+CRP and CRP+AFI curves were 0.952,0.942,0.913,0.939 and 0.950,suggesting that the five combined indexes could be used for monitoring intrauterine infection which has higher accuracy.6.Comparison of pregnancy outcomes:6.1 Comparison of cesarean section rate of two groups of pregnant women:There were 155 cases in this study,including 32 cases of cesarean delivery(20.55%),Among the 67 cases of intrauterine infection group,23 cases were delivered by cesarean section,indicating that fetal distress took the first place(47.83%).In the group of 88 cases without intrauterine infection,9 cases were delivered by cesarean section,indicating that the first was fetal distress(33.33%)and labor induction failure(33.33%).The difference of cesarean section rate between the two groups was statistically significant(P<0.05).6.2 Analysis of adverse pregnancy outcomes in two groups:The incidence rates of postpartum fever,postpartum hemorrhage,neonatal hyaline membrane disease,neonatal pneumonia and neonatal myocardial damage in the intrauterine infection group were significantly higher than those in the group without intrauterine infection,with statistically significant differences(P<0.05).There was no significant difference between the two groups in respiratory distress syndrome,neonatal sepsis and neonatal mortality(P>0.05).6.3 Analysis of the levels of clinical indicators and adverse pregnancy outcomes:There were significant differences in the number of leukocytes,percentage of neutrophils,procalcitonin,C-reactive protein and amniotic fluid index between the groups with good pregnancy and those with poor pregnancy.The number of leukocytes,the percentage of neutrophils,the high expression level of procalcitonin and C-reactive protein,and the low expression level of amniotic fluid index are related to the adverse pregnancy outcome of prom.Conclusions1.The single index with the highest sensitivity to intrauterine infection monitoring in our hospital was NE%(89.55%),the single index with the highest specificity was AFI(97.73%),the double index with the highest sensitivity to intrauterine infection monitoring was WBC+NE%(74.63%)and PCT+CRP(74.63%),and the double index with the highest specificity was PCT+AFI(98.86%).2.Premature rupture of membranes with intrauterine infection increased the rate of cesarean section,resulting in premature delivery,postpartum fever,postpartum hemorrhage,neonatal hyaluronic membrane disease,neonatal pneumonia,neonatal myocardial damage and other adverse outcomes. |
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