| Objective:The aims of this study were to study the main influencing factors,maternal and infant outcomes andthetype of pathogens in patients with premature rupture of membrane(PROM)combined with histologic chorioamnionitis(HCA)and clinical chorioamnionitis(CCA),so as to provide theoretical foundations for clinical early warning and targeted treatment.Methods:336 patients with PROM at the Second Hospital of Shanxi Medical University from August 1,2016 to July 31,2018 were included in this study.These 336 patients were divided into 4 groups according to the pathological results of placental membranes,namely control,mild inflammation,medium inflammation and severe inflammation group.All clinical data of 4 groups PROM patients including:age,height,weight,pre-pregnancy BMI,pregnancy,delivery gestational week,latent period of membrane rupture(ie,time of membrane rupture to fetal delivery),neonatal weight,newborn 1 minute Apgar score,blood cell analysis,ultrasound examination of amniotic fluid index,cervical secretion culture results were collected and analyzed.Data analysis was performed by SPSS 24.0 statistical software.Results:1.The incidence of PROM patients with HCA in this study was 69.6%(234/336),and the incidence of grade I,II and III HCA were 44.9%(151/336),11.0%(37/336)and 13.7%(46/336)respectively.2.In these 234 patients with HCA,only 2 patients had CCA,and the pathological results were all grade III HCA.3.The patients’basic clinical data:age,height,weight,pre-pregnancy BMI and pregnancy were not significantly different among the four groups of PROM patients(P>0.05).4.The latent period of membrane rupture in 4 groups of PROM patients were(20.7±22.3)h,(22.1±20.6)h,(33.7±25.1)h,(39.6±39.1)hrespectively.The difference of the latent period of membrane rupture was statistically significant(H=23.613,P<0.001).5.The positive rate of HCA was 64.5%(142/220)in PROM patients with a latent period of membrane rupture≤24 h,and the positive rates of grade I,II and III HCA were 48.2%(106/220)and 7.3%(16/220),9.1%(20/220)respectively.The positive rate of HCA was 75.7%(53/70)in the PROM patients with a latent period of membrane rupture were 24-48 h,and the positive rates of grade I,II and III HCA were 41.4%(29/70)and 18.6%(13/70),15.7%(11/70)respectively.The positive rate of HCA was 84.8%(39/46)in PROM patients with a latent period of membrane rupture>48 h,and the positive rates of grade I,II and III HCA were 34.8%(16/46)and 17.4%(8/46),32.6%(15/46)respectively.The severity of HCA increased significantly with the extension of the latent period of membrane rupture(trend testχ~2=26.634,P<0.001).6.140 patients of PROM underwent ultrasonic measurement of amniotic fluid index after rupture of membrane.The amniotic fluid index of the four groups PROM patients were(9.1±4.0)cm,(8.2±3.9)cm,(9.6±5.0)cm,and(9.5±3.1)cm respectively.There was no significant difference in the amniotic fluid index among the four groups(F=1.078,P=0.361).7.A total of 218 patients underwent cervical secretion culture and drug sensitivity after admission,and the positive rate of pathogen was 49.1%(107/218).Cervical secretion culture results showed that the positive rate of Staphylococcus was the highest among the pathogens in four groups of PROM patients,followed by Candida,however,the Streptococcus,mixed infection(two or more pathogenic infections)and other pathogen infections(such as Escherichia coli,Gardnerella vaginalis,Enterococcus faecium and Enterobacter cloacae)were few.There was no statistical difference among them(P=0.350,derived from Fisher’s exact probability method).As the degree of HCA increased,the positive rate of lactobacilli decreased gradually,but the difference was not statistically significant(χ~2=6.348,P=0.096).8.The differences of preterm birth rate,cesarean section rate,postpartum hemorrhage rate,neonatal birth weight and 1-minute Apgar score among the 4 groups of PROM patients were not statistically significant(P>0.05).9.The incidence of fetal distress in the 4 groups of PROM patients was 12.7%(13/102),11.9%(18/151),27.0%(10/37),and 32.6%(15/46)respectively.The incidence of fetal distress increased significantly with the severity of HCA(trend testχ~2=11.327,P=0.001).Conclusions:1.The longer the latent period of membrane rupture in PROM patients,the higher incidence of HCA and the more serious of its degree.2.In this study,the positive rate of Staphylococcus was the highest in cervical pathogens of PROM patients,followed by Candida.3.The more severe degree of HCA in patients with PROM,the higher incidence of fetal distress. |
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