| Background and aimsPreterm premature rupture of the membranes (PPROM) is defined as prelabour rupture of the membranes prior to 37 weeks of gestation. PPROM occurs in 2.0% to 3.5% of all pregnancies and is responsible for 30% to 40% of preterm births. People find that the more near term, the higher incidence of PPROM. It occurs in 19% before 34 weeks of gestation and 81% after 34 weeks of gestation. The membranes'break of PPROM only 7.7% to 9.7% can heal naturally. PPROM can lead to a series of complications as amniotic connected with the outside world and the continuous leaking of amniotic fluid. PPROM not only can lead to chorioamnionitis, dystocia, umbilical cord prolapse, placental abruption, and postpartum hemorrhage with mother, can also lead to premature delivery, fetal distress, limbs deformation and contracture, fetal position change, neonatal infection, and death with fetus and neonatal. PPROM make preterm birth rate, perinatal child mortality, intrauterine infection and puerperal infection rates rise because of the adverse effects on pregnancy, the most important problem is the result of premature newborns with respiratory distress syndrome (RDS) and the mother-fetal infection, so that, PPROM is one of serious obstetric complications. Since the 50's since the 20th century, people began to explore the cause of preterm premature rupture of membranes and pathogenesis, but its exact cause is not yet fully understood, considered to be caused by multiple factors, PPROM is lack of fundamental methods of prevention.That how to deal with PPROM has become a difficult and challenging problem. Due to the differences on best treatment plan and levels of health care, there is no uniform treatment of domestic and international norms about PPROM and there are some differences at home and abroad. The earlier PPROM occurs, the more difficult about its clinical treatment. To reduce the threat of premature delivery, on the one hand people try to extend gestational age by the application of tocolytic, to promote fetal lung maturity in order to obtain viable fetus and newborn to improve the quality of life. On the other hand with the miscarriage treatment time, the amniotic fluid continued to leak, the likelihood and severity of infection will increase, severe oligohydramnios and fetal and neonatal infections often affect the development, lead to other serious concurrent parent child Disease can be life-threatening. Expectant treatment or termination of pregnancy should consider from weeks of gestation, fetal maturity, with or without amniotic infection, maternal complications caused by rupture and the local level of preterm infant's treatment (in particular the level of neonatal intensive care). In recent years, with the wide and positive application of antibiotics, corticosteroids and tocolytic risks on maternal and perinatal children decline but still exists. How to intervene PPROM so as to minimize the danger and access the possibility to lower maternal infection rate, perinatal mortality and mortality, which has been one of the focus in the medical profession.In this study,288 cases of preterm premature rupture of membranes on the clinical data were reviewed, focusing the susceptible factors and the impact on maternal and neonatal outcomes and contro of PPROM, in order to enhance the awareness of PPROM, decline its incidence and reduce maternal and child hazards. Materials and Methods1 Subjects and groupsSelected 288cases of the patients with PPROM who were treated in the Changge City People's Hospital of Henan Province from January 2006 to January 2011. These cases were divided into 2 groups according to the rupture of membranes gestational age:the group of 28～33+6weeks and the group of 34～36+6 weeks,and were stratified aceording to the duration of PPROM in three groups:<24h,24～72h, and>72h.2 diagnostic criteriaDiagnostic criteria consult "Obstetrics and Gynecology" (the seventh edition) which was published in people's health press. Pregnant women complained sudden outflow of liquid from the vagina, and then a small amount of intermittent discharge. When Increased abdominal pressure happen such as sneezing, weight, coughing, the amniotic fluid is out on, we will see more fluid volume flow on if push on the ministry of fetla when we do the rectal examination, you can confirm the diagnosis. Auxiliary examination:vaginal examination revealed cervical and amniotic fluid from the cervical os out; Litmus paper pH value≥6.5;vaginal fluid smear see fern drying crystallization; straw suck out the liquid applied to the slide in the cervical canal, the alcohol burner for 10 minutes change brown as the cervical mucus into the amniotic fluid white;Amniotic microscope could not see before the amniotic sac.3 treatment after admissionThese cases were gived usual care after admission by premature rupture of membranes, bed rest and raise the buttocks, keep the vulva clean,against unnecessary digital rectal examination and vaginal digital examination; according to medical history and ultrasound examination to determine gestational age, fetal growth and fetal position, with or without residual amniotic fluid volume and fetal abnormalities in general, to observe the maternal body heart rate, temperature, the uterus with or without tenderness, vaginal fluid flow conditions and white blood cell counts.if we suspect there has signs of infection for those we need do ultra-sensitive C-reactive protein (CRP). For>34 weeks gestation or ultrasound fetal biparietal diameter close to or greater than 8.5cm,who estimated that the fetus has matured, and timely termination of pregnancy; for gestational age<34 weeks, fetal monitoring the situation closely and actively to look forward to If premature birth can not be avoided, we gave the glucocorticoid dexamethasone immediately to promote fetal lung maturity 10mg intramuscular injection; if the expectant treatment.are given effectively, we gave dexamethasone miscarriage 6mg, one every 12 hours, a total of 4 times intramuscular injection, intravenous infusion of 25% while magnesium sulfate 30-60ml/d or ritodrine 50～100mg/d at the same time to suppress uterine contractions; rupture of membranes 12 hours or more routine use of antibiotics to prevent infection.If signs of labor, intrauterine infection, fetal distress and other obstetric indications for termination of pregnancy occurs in continuous monitor, regardless of gestational age size, terminate of pregnancy.4 Statistical methodsAll data were processed using statistical software SPSS 17.0, measurement data between the two groups were taken by t test and rank sum test; Counted data were usedχ2 test and Fisher exact test. Statistically significant level was considered as "α= 0.05".Results1 General condationSelected 288cases of the patients with PPROM who were treated in the Changge City People's Hospital of Henan Province from January 2006 to January 2011. premature rupture of membranes accounted for 22.43%, the number of preterm 13.2 %,2.52% of total deliveries. Preterm premature rupture of membranes occurred for women aged 18 to 45 years, mean (26.5±5.5) years,230 cases of primipara, the maternal 58 cases,254 cases of single births, twins in 32 cases, three children in 2 cases.28～33+6 weeks of gestation group 128 patients, accounted for 44.4%,34～36+6 weeks of gestation group of 160 patients, accounted for 55.6%, the two groups in age and pregnancy had no statistical difference between sub-areas (P>0.05), were comparable. The shortest duration of rupture of membranes break 1h, the longest 764h, the average 50.86h, where <24h 112 cases,24～72h were 117 cases,> 72h 59 cases.28～33+6 weeks of pregnancy group the median duration of rupture of membranes break 2.9 days, more than 34～36+6 weeks of gestation group,0.7 days, there is statistical difference between the two (P<0.01). Childbirth newborn 324,295 survived,29 patients died, including 28～33+6 weeks of pregnancy, newborn group of 133 patients,34～36+6weeks of gestation group of 191 cases of newborns; rupture break duration <24h group of students Children in 121 cases,24～72h group of 129 patients,> 72h group of 74 patients.2 susceptible factors of PPROMIn this study,118 patients with multiple pregnancy, vaginitis in 52 cases,38 cases of breech presentation, twins, three children 34 patients prone as the main factors, accounting for 41.0%,18.1%,13.2% and 11.8%, the other also There were 8 cases of pregnancy induced hypertension (2.8%), polyhydramnios in 6 cases (2.1%), gestational diabetes mellitus in 5 cases (1.7%), cervical incompetence within the mouth in 3 cases (1.0%), merged the uterus Deformity in 2 cases (0.7%), sexual intercourse in late pregnancy in 2 cases (0.7%), uterine scar in 2 cases (0.67%), abdominal trauma in 1 case (0.3%), there are most of the 98 cases with unknown causes (34.0%), in Table 1. Some patients had one or two more prone factors, the number of cases there is duplication.3 Comparison of mode of delivery of PPROM288 cases of pregnant women in preterm premature rupture of vaginal delivery in 195 cases, of which 176 cases of spontaneous delivery (61.1%), vaginal delivery in 19 cases (6.6%), cesarean section in 93 cases (32.3%).Some cases had one or two more indications for cesarean section, such as abnormal fetal position,multiple pregnancy,complications after PPROM and other social factors, this study of 93 patients selected statistical main indications for cesarean section were:breech presentation in 29 cases (31.2%), twins, three children in 27 cases (29.3%), cord around neck in 10 cases (10.8%),8 cases of fetal distress (8.6%),6 cases of oligohydramnios (6.5%), pregnancy induced hypertension 5 Cases (5.4%), umbilical cord prolapse in 4 cases (4.3%), placental abruption,3 cases (3.2%), uterine malformation in 1 case (1.1%), breech presentation and multiple gestation as the main indication for the caesarean section.28～33+6 weeks of pregnancy,128 cases in the natural delivery group of 83 patients (64.8%), vaginal delivery in 11 cases (8.6%), cesarean section in 34 cases (26.6%); 34～36+6weeks of gestation group of 160 cases Natural childbirth in 93 cases (58.1%), vaginal delivery in 8 cases (5.0%), cesarean section in 59 cases (36.9%), dystocia rates were 54.2%,63.1%, no significant difference between the two groups (x2=1.656, P=0.198> 0.05).Rupture duration<24h group,112 cases of spontaneous labor in 70 cases (62.15%), vaginal delivery in 4 cases (3.6%), cesarean section 38 cases (33.9%); 24～72h group of 117 patients in 76 cases of spontaneous labor (65.0%), vaginal delivery 6 (5.1%), cesarean section 35 cases (29.9%);> 72h 59 patients in the natural delivery group 30 cases (50.8%), vaginal delivery in 9 cases (15.3%) Cesarean section in 20 cases (33.9%), three groups of dystocia rates were 37.5%,35.0%,49.2%, the difference was not statistically significant(χ2=4.599, P=0.100> 0.05).4 Comparison of neonatal outcomesStatistical analysis of perinatal newborn, including neonatal infection, respiratory distress syndrome, intracranial hemorrhage, neonatal asphyxia and the number and percentage of cases of death,34～36+6 weeks of gestation group with low incidence rates of neonatal complications and death compared with pregnancy 28～33+6 weeks, a statistically significant difference between the two (P=0.000<0.01). Neonatal outcomes of different rupture duration comparison,28～33+6 weeks of gestation with rupture duration group, the incidence of neonatal respiratory distress syndrome in the lower, but there hads no statistical difference (χ2=1.673, P=0.433>0.05), increased incidence of neonatal infections, and reduced the incidence of intracranial hemorrhage, there was statistical difference (P<0.05); neonatal mortality rate with prolonged rupture of membranes has decreased, but the difference was not statistically significant (χ2=0.413, P= 0.813>0.05). In the 34～36+6 gestational weeks, the duration of rupture of membranes and respiratory distress syndrome in a negative correlation between the incidence of, but not statistically significant(χ2=0.952, P=0.710> 0.05); and 28～33+6 weeks of pregnancy, the same group, Premature rupture of membranes longer the greater the chances of neonatal infection, there was statistical difference (χ2=11.728, P=0.001<0.01); but with the gestational age increased, intracranial hemorrhage, and death of newborn continue to reduce the probability.5 Comparison of maternal outcomes28～33+6 weeks of gestation group had 20 cases of puerperal infection (15.6%), 5 cases of postpartum hemorrhage (3.9%), placental abruption, in 2 cases (1.6%); 34～36+6 weeks of gestation group of puerperal infection occurred 6 cases (3.8%), postpartum hemorrhage in 6 cases (3.8%), placental abruption,3 cases (1.9%), two groups of puerperal rates were significantly different (χ2=12.210, P=0.000<0.01).Rupture duration <24h group of puerperal infection occurred in 3 cases (2.7%), postpartum hemorrhage in 2 cases (1.8%),; 24～72h group of puerperal infection occurred in 8 cases (6.8%), postpartum hemorrhage in 3 cases (2.6%), placental abruption, in 2 cases (1.7%);> 72h group had 15 cases of puerperal infection (25.4%), postpartum bleeding in 6 cases (10.2%), placental abruption,3 cases (5.1%), three groups of puerperal rates were significantly different (χ2=25.493, P=0.000<0.01);. The incidence of postpartum hemorrhage and placental abruption increased, but not statistically significant (P>0.05).Conclusion1 Preterm premature rupture of membranes can lead to a series of serious obstetric complications, incidence of maternal child infections, neonatal respiratory distress syndrome, and asphyxia. increased.2 Neonatal outcomes are closely related with the gestational age, the smaller the gestational age, the poorer neonatal outcomes; when gestational age >34weeks, neonatal outcomes improved significantly.3 With the rupture duration, the incidence of neonatal respiratory distress syndrome decreased, but the risk of maternal child infections increase; Whether expect treatment or termination of pregnancy should be weighed in consideration for gestational age<34 weeks of preterm premature rupture of membranes.4 The delivery mode in PPROM is not related to PPROM itself, but depends on the clinical condition. |
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