【作者】 王炎；

【导师】 孙玉秀；

【作者基本信息】 吉林大学 ， 临床医学， 2007， 硕士

【摘要】 目的:探讨早产的病因、相关危险因素,减少母儿不良结局。方法:回顾性分析吉林大学第一临床医院与梅河口市医院1999年1月至2006年12月分娩的302例早产病例设为早产组,随机查取两院同期有可比性的足月分娩病历302例设为对照组。分析早产发生的相关危险因素、病因及对母儿的影响。并对孕37-≥34周、34-≥32周、32-≥30周、30-≥28周,早产分娩者做比较,分析不同孕周早产儿结局。同时对<34孕周的足月前胎膜早破(PPROM)所致的早产是否进行保胎治疗对母儿的影响进行分析比较。结果:同期分娩总数7948例,早产302例,早产发生率为3.8%。以胎膜早破、胎盘因素、双胎、胎位异常、妊娠期肝内胆汁淤积症(ICP)和妊娠期高血压疾病为早产主要原因,但是仍有相当一部分原因不明,其中不明原因约占14.90%。年龄≥35岁、孕期各种生殖道感染、有早产、流产史及妊娠期中、重度贫血及低经济收入阶层、未接受孕期保健者为早产高危人群。对于<34孕周的PPROM所致的早产产前给予糖皮质激素联合抗生素及宫缩抑制剂保胎治疗,和胎儿娩出后对早产儿及时应用肺泡表面活性物质,能有效降低围产期死亡率。新生儿窒息、死亡、低体重儿的发生率在早产组明显高于对照组,差异有显著性(P<0.05);早产组低体重儿,新生儿窒息率及死亡率在28-30周之间者最高并随孕周增加明显减少。对产妇影响方面,早产组不增加剖宫产率及阴道助产率,但产后出血率较对照组明显增高,差异有显著性(P<0.01)。结论:早产的相关危险因素有:生殖道感染、年龄≥35岁、反复流产、早产史及低经济收入阶层、未接受孕期保健、妊娠期中、重度贫血。早产是多因素共同作用的结果,其中胎膜早破、胎盘因素、原因不明、双胎、胎位异常、ICP、妊娠高血压疾病等是早产的主要病因。早产增加低体重儿、新生儿窒息、死亡的发生率,其发生与孕周呈明显相关性。孕周越低,发生率越高;合并症越重,预后越差。对产妇影响方面,早产不增加剖宫产及阴道助产,但产后出血增高。对<34孕周的PPROM产前给予保胎治疗、延长孕龄可降低围生儿死亡率。更多还原

【Abstract】 Objective A preterm birth is one that occurs full 28 weeks to less 37 weeks (196-258 days) of gestation.The preterm birth mobidity is about 5%-15%. An infants born at less than 37weeks of gestation are at risk for morbidity and mortality heighten due to organs and immuature function prematurity. 15 precent of premature infant will death within neonatal period, 8 precent of premature infant who is survival can make ingering effects of dysgnosia and nervous system. It reports that premature delivery is the leading cause of 75% perinatal morbidity and mortality, besides the fatal malformation. Development of the intensive care have obviously decrease the mortality rate of premature infant and improved the exist state of prematue infant, but the incidence rate of premature delivery still have no obviously decrease. Premature delivery still is one of important causes to the perinatal death. Hence, understanding the related factors and the cause of premature delivery is necessary. It is very important to prevention and treatment actively. This study is to discuss the related risk factors of premature delivery、the cause of premature delivery and maternal and fetal prognosis.Methods: We analyzed retrospectively the 302 cases of premature delivery from January, 1999 to December, 2006 (premature delivery group) and 302 cases of full-term delivery that we drownrandom at the same time (control group). We compared premature delivery during 28 weeks to less 32weeks、32 weeks to less 34 weeks and 34 weeks to less 37 weeks and analyzed the outcome of premature infants in different weeks of gestation. Contrasting analysis was performed about the influence of tocolysis and nontocolysis therapy on the pregnant women and fetus with premature delivery from preterm premature rupture of membrane (PPROM) in 34 gestational weeks.Results: The incidence of preterm delivery is 3.8% of all births in the past 8 years in our hospital. The main causes of premature delivery is premature rupture of the membranes and it is 40.07% among all cases, the second is placental facters 15.23%, sequentiaei in order are Double pregnancy 9.93%、Abnormal fetal position 8.94%、Intrahepatic cholestasis of pregnancy 4.97%、Hepertencive disorder complicating pregnancy 4.97%、others 0.99%and premature delivery with unknown causes 14.90%. There is a significant difference between tow groups in premature rupture of membrane、placental facters、Abnormal fetal position、Double pregnancy、Intrahepatic cholestasis of pregnancy P<0.05, There is no significant difference between tow groups in hepertencive disorder complicating pregnancy P>0.05.Crvicovaginitis is 39.74% among all the related risk factors of premature delivery, pregnancy with Crvicovaginitis or≥35 yearsold、recurrent abortion and premature delivery history、low society layer、low income and no antenatal care、midrange or serious anaemia in gestation period has more incidence rate of premature delivery, there is a significant difference between two groups P<0.05. There is no significant difference between two groups in pregnancy of≤18岁、antepartum hemorrhage P>0.05.Incidence rate of asphyxia of neonatal、death of neonatal、low birth weight infant in premature delivery group is higher than control group, there is a significant difference between the two groups P<0.05. The more decrease the gestational age, the more incidence rate ofllow birth weight infant、asphyxia of neonata and mortality the perinatal. There is no significantly different of the incidence of cesarean section and vaginato assist delivery between the groups of preterm and full-term delivery, but incidence of postpartum hemorrhage in premature delivery group is higher than control group, there is a significant difference between the two groups P<0.01.Tocolysis management including prenatal glucocorticoid combined with antibiotics and suppress antofuterine contraction could effectively lower the low birth weight infant、neonatal scleredema、hyaline membrane disease、asphyxia of neonata and the perinatal mortality in the patients with premature delivery from PPROM in 34 gestational weeks.Conclusion: The related risk factors of premature deliveryincluding: Crvicovaginitis、≥35 years old、recurrent abortion and premature delivery history、low society layer、low income and no antenatal care、midrange or serious anaemia in gestation period. premature rupture of the membranes and placental facters、Double pregnancy、Abnormal fetal position、Intrahepatic cholestasis of pregnancy、Hepertencive disorder complicating pregnancy、others and premature delivery with unknown causes are main main causes of pre- mature delivery. Premature delivery can increase the incidence rate of asphyxia of neonatal、death of neonatal、low birth weight infant. Premature delivery can not increase the incidence of cesarean section and vaginato assist delivery,but increase the incidence of postpartum hemorrhage. Tocolysis management including prenatal glucoco- rticoid combined with antibiotics and suppress antofuterine contrac- tion could effectively lower the perinatal mortality in the patients with premature delivery from PPROM in 34 gestational weeks.更多还原