Clinical Analysis Of Risk Factors And Prognosis Of 274 Cases Of Premature Rupture Of Membranes

Objective:Studies have shown that many reasons can cause premature rupture of membranes,including pregnant women’s home environment,living habits,maternal health,fetal development and physiological and pathological changes.At present,although there is a standardized consensus on the treatment of premature rupture of membranes in clinical practice,its pathogenesis is still unclear.Therefore,it is very difficult to predict and prevent the occurrence of premature rupture of membranes.Through retrospective analysis,this study explored the risk factors of premature rupture of membranes and their impact on maternal and infant pregnancy outcomes,so as to formulate individualized intervention programs for pregnant women,reduce the occurrence of premature rupture of membranes,improve maternal and infant outcomes,and provide certain clinical basis for the diagnosis and treatment of premature rupture of membranes.Methods:274 patients with PROM admitted to the obstetrics department of Jilin Provincial People’s Hospital from January 2020 to December 2022 were selected as the case group,divided into PPROM group and TPROM group.The PPROM group included 34 cases of miscarriage at 24-27⁺⁶weeks,190 cases of premature delivery at 28-36⁺⁶weeks,and 50cases of full term delivery at 37-40 weeks;200 pregnant women without premature rupture of membranes admitted to obstetrics during the same period were selected as the control group,including 30 cases of miscarriage at 24-27⁺⁶weeks,133 cases of premature delivery at 28-36⁺⁶weeks,and 37 cases of term delivery at 37-40 weeks.A total of 474 study subjects were included.We studied the general clinical data of the case group and the control group,as well as the complications of PROM with other diseases,vaginal secretions,and maternal peripheral blood inflammatory indicators.By analyzing the VVC,TV,WBC,NE%,and CRP indicators related to PROM occurrence,establish a predictive model for ROC diagnosis of PPROM,and compare the differences in adverse pregnancy outcomes between mothers and infants.Results:1.The median weight gain during pregnancy was 13.5 kg in the case group and 10.0kg in the control group.The case group was significantly higher than the control group,with a statistical difference between the two groups（P<0.05）.2.The proportion of PROM group complicated with 3 or more other diseases was47.5%,while the proportion of control group was 22.0%.The proportion of PROM group complicated with other diseases was significantly higher than that of control group,and there was a statistical difference between the two groups（P<0.05）.3.There was a statistical difference（P<0.05）between the PPROM group and the immature control group in terms of VVC and TV;There was no statistically significant difference between the TPROM and full-term control groups（P>0.05）.There was no statistically significant difference in BV and GBS between the PROM group and the control group（P>0.05）.4.The correlation between VVC,TV,and PPROM in vaginal secretions was determined through chi square test.Non conditional logistic regression analysis was used to determine that WBC,NE%,and CRP were only associated with PPROM.Therefore,a predictive model for diagnosing PPROM with ROC was established using indicators such as VVC,TV,WBC,NE%,and CRP.By comprehensively comparing the area under the ROC curve,it was found that the maximum area under the curve of the WBC+CRP+TV+VVC combined predictive model was 0.761 at weeks 24-27⁺⁶of pregnancy,with a 95%confidence interval of 0.639-0.883,The sensitivity is 58.8%,the specificity is 93.3%,and the Yordan index is 52.1%.The maximum area under the curve of the NE%+CRP+TV+VVC combined prediction model at 28 36⁺⁶weeks of pregnancy is0.821,with a 95%confidence interval of 0.776-0.866,sensitivity of 73.7%,specificity of84.0%,and Yordan index of 57.7%.5.The incidence of cesarean section during full term pregnancy was 62.0%in the case group and 18.9%in the control group.The cesarean section rate in the TPROM group was significantly higher than that in the control group,and there was a statistical difference between the two groups（P<0.05）.6.The incidence of postpartum infection in the PPROM group was significantly higher than that in the control group,and there was a statistical difference between the two groups（P<0.05）;There was no statistically significant difference（P>0.05）between TPROM and the full-term control group.The incidence of postpartum hemorrhage in the case group(28-36⁺⁶weeks,37-40 weeks)was significantly higher than that in the control group,and there was a statistical difference between the two groups（P<0.05）.7.The incidence of neonatal pneumonia and conversion to neonatal pediatrics in the PPROM group was significantly higher than that in the control group,and there was a statistical difference between the two groups（P<0.05）;There was no statistical difference between the TPROM group and the control group（P>0.05）.Conclusion:1.Excessive weight gain during pregnancy;Pregnant women with three or more other diseases are risk factors for PROM.2.VVC,TV,WBC,NE%,and CRP are related factors for the onset of PPROM.The combined detection of WBC,CRP,TV,and VVC at 24-27⁺⁶weeks of pregnancy has certain value in predicting the risk of PROM occurrence;The combined detection of NE%,CRP,TV,and VVC at 28 to 36⁺⁶weeks of pregnancy has certain value in predicting the risk of PROM.3.PPROM leads to an increased incidence of postpartum infections,postpartum hemorrhage,and neonatal pneumonia,while TPROM leads to an increased incidence of postpartum hemorrhage and cesarean section.