Research Of The Association Of PROM、placental Pathology With Neonatal Outcomes

Objective:To study the premature rupture of membranes (premature rupture of membrane, RPOM) and placental pathology (placental pathology), and neonatal outcomes, assess pathological examination prognostic significance for patients with premature rupture of membranes newborn.Materials and Methods:(1) The object of study:January1,2012to2012, Southern Medical University, Southern Medical obstetrics and gynecology hospital childbirth in patients with premature rupture of membranes, gestational age≥28weeks, a total of454cases as the observation group; another randomly selected2012Nanfang Hospital of Obstetrics and Gynecology, hospital delivery of non-premature rupture of membranes maternal cases of107patients as a control group. The above two groups switch departments newborn followed up examination during the neonatal hospitalization, check the indicators to assess neonatal complications.(2) research methods:research indicators:the patient’s general information:age, gestational age, maternal time, risk factors are combined, length of stay, hospital costs; the obstetric specialist information:placental pathology type, placental pathology inspection report rupture, rupture of the specific time, rupture of amniotic fluid, whether to prevent infection, prevention of infection time, drug, dose, time of delivery, mode of delivery, childbirth amniotic fluid; newborn:newborn Apgar’s score, neonatal asphyxia, neonatal switch departments, rate, and switch departments related condition assessment indicators:birth weight, C-reactive protein (C reactive protein CRP), total bilirubin, white blood cells, brain imaging, blood culture. Statistical Methods:Measurement data using±SD count data rate that the measurement data is the first test of normality and homogeneity of variance test, the same data showed a normal distribution and homogeneity of variance, analysis of variance (one-way ANOVA); analysis of the data was normal distribution and heterogeneity of variance using the approximate variance based on the heterogeneity of variance. Twenty-two compared using LSD method (homogeneity of variance) or Dunnett T3method (arrhythmia) of variance test. Used to compare rates the line×list of multiple samples non-parametric tests (Kruskal-Wallis method). Test level to take alpha=0.05, results P<0.05as significant difference. All data processing by SPSS19.0statistical package complete.(3) placental pathology specimens:premature rupture of membranes diagnosis pregnant women, after delivery of the placenta by the obstetrician or midwife, sterile scissors, as far as possible in the mouth close to the rupture of the membranes take diameter about4cm placental membranes, installed aseptic bags, fixed in formalin liquid censorship. Placental tissue producer in accordance with the standard HE staining method, interpretation of pathology films according to the following criteria chorioamnionitis, chorioamnionitis grading:Ⅰ Class:neutrophil infiltration too few and scattered, are largely confined to the fluff board fibrin deposits or membranes decidua layer; Ⅱ:infiltration of neutrophils increased, and extends to the chorionic tissue or the fluff board organization and fetal blood vessels, but not yet into the amniotic membrane; Ⅲ:neutrophil extensive infiltration of the decidua or chorionic, and has reached the amniotic membrane; chronic inflammatory changes:chorionic and amniotic lymphocytes and plasma cells. Results:(1) In general contrast:the observation group (premature rupture of membranes) with the control group (not premature rupture of membranes) age, the rate of cesarean section was no significant difference (P>0.05), prompted age does not constitute tires premature rupture of membranes and the gestational age of the influencing factors of premature rupture of membranes, premature rupture of membranes did not result in obvious increase in the rate of cesarean section. Observation group and the control group on gravidity, parity, length of hospital stay and costs a significant difference, which production times, the number and cost of hospital days and exist significant difference prompt motherhood times increased, especially the increase in production times is constituted tire risk factors of premature rupture of membranes. Premature rupture of membranes significantly prolonged hospitalization time, increase the cost of hospitalization. Neonatal, rate of turn, intravenous antibiotic usage there is a significant difference (P<0.01), premature rupture of membranes, increased the rate of neonatal switch departments, intravenous antibiotic usage. Observation group in gestational age<34weeks cases96.2%used antibiotics, neonatal switch departments rate of92.3%.(2) control group placenta inspected, of which eight cases prompted chorioamnionitis, chorioamnionitis was7.5%, the observation group chorioamnionitis, chorioamnionitis incidence rate of61.0%(282/462), there are statistically significant differences with the observation group. Chorioamnionitis, incidence of chorioamnionitis and inflammation severity gradually increased with decreasing gestational age, full-term fetal membranes group rate was61.5%(193/314), gestational age is between28-34weeks The PPROM group the incidence of78.8%(41/52).(3) delivery time different from the length of the film rupture time, in placental pathology showed significant difference, the longer the delivery time from the film rupture time chorioamnionitis, chorioamnionitis increased occurrence probability, severity of inflammation. When cases of premature rupture of membranes24hours before delivery, chorioamnionitis/chorioamnionitis the incidence of68.98%(109/158).(4) A total of202cases of pregnant women with premature rupture of membranes newborn Proposed Transfer Division, but the follow-up of the neonatal hospital follow-up to the170cases,32cases were lost to follow. Control group,107cases of premature rupture of membranes pregnant women, a total of29cases recommended to switch departments, but the follow-up found in6cases were lost to follow-up to23cases.) The PROM group of neonatal CRP was significantly higher than that of newborn premature rupture of membranes, premature rupture of membranes neonatal infection rates were higher, the rupture of the earlier gestational age, the infection rate was gradually increased, pregnant weeks<34weeks of the newborn, the infection rate was92%(23/25), the observation group,103cases of neonatal blood cultures, of which102cases prompt bacterial and fungal growth,1patient Mycobacterium growth; control group4cases of blood culture, are suggestive of bacterial and fungal growth. The observation group of134cases of neonatal cranial imaging studies, of which110cases of normal,10cases prompted hypoxic-ischemic encephalopathy,14cases of simple tips transparent compartment widened. The control group of13cases of brain imaging, it was discovered intracranial hemorrhage in1case, kernicterus cases, no prompts the cases of hypoxic-ischemic encephalopathy. Due to the small sample size of the control group, did not find a statistically significant difference, but intracranial hemorrhage, neonatal hypoxic-ischemic encephalopathy, etc. showing an upward trend.(5) patients with severe chorioamnionitis length of stay, cost of hospitalization, serum white blood cells, C-reactive protein are higher than other patients; patients with chorioamnionitis and severe neonatal infections related indicators (white blood cells, C-reactive protein) and neonates when ratings are significantly higher than the other patients (P<0.05).Conclusion:(1) the occurrence of premature rupture of membranes and motherhood, In addition, no significant correlation with the patient’s age; premature rupture of membranes is a significant increase in the length of hospital stay and hospital costs.(2) premature rupture of membranes occurred earlier the gestational age, chorioamnionitis/chorioamnionitis higher incidence of moderate to severe chorioamnionitis proportion is also showing an increasing trend, suggesting premature rupture of membranes and infection closely related; premature rupture of membranes (especially<34weeks patients) neonatal incidence of infection, asphyxia and neonatal nervous system disease incidence tended to increase;(3) rupture of time from the time of delivery is the longer, chorioamnionitis/chorioamnionitis higher incidence of moderate to severe chorioamnionitis proportion is also showing an increasing trend,12hours after childbirth increase is particularly evident, Tip If premature rupture of membranes over12hours of non-delivery, chorioamnionitis/chorioamnionitis risk of a significant increase, you should consider using the appropriate antibiotics in a timely manner, preferably intravenous antibiotics.(4) the presence and extent of chorioamnionitis/chorioamnionitis with maternal length of stay, hospital costs, CRP, WBC were significantly related to the more severe chorioamnionitis, neonates lower the score, neonatal incidence of asphyxia, the higher the incidence of infection higher infectious indicator; severe chorioamnionitis/chorioamnionitis seems to imply that the emergence of maternal and fetal poor prognosis.(5) in patients with premature rupture of membranes for pathological examination help to help determine maternal and neonatal clinical outcomes, and provide a strong basis for clinical anti-infective therapy, for conditional medical institutions, it is recommended that patients with premature rupture of membranes delivery the placenta to send routine pathological examination.