【作者】 郭伟；

【导师】 崔世红；

【作者基本信息】 郑州大学 ， 妇产科学（专业学位）， 2014， 硕士

【摘要】 早产指妊娠满28周至不足37周（196～258日）间分娩者。早产按原因可分为自发性早产（SPB）、未足月胎膜早破早产（PPROM）和治疗性早产（IPD）3类，其中SPB为最常见的类型。SPB是多方面因素作用的结果，既往早产史、文化程度低、产检次数少、宫内感染等是引起SPB的常见高危因素。孕周是影响早产患者妊娠结局的主要因素，有文献指出孕32周之前分娩的早产儿最常见的并发症为新生儿呼吸窘迫综合征（NRDS），其发生率及死亡率均明显高于32周后分娩者。因绒毛膜羊膜炎在SPB与PPROM发病机制中均起重要作用，既往多将两者合称为特发性早产进行研究。近来有文献指出胎膜早破容易引起宫内感染，从而造成新生儿窒息、新生儿感染等，故将两者分开研究进行早产儿结局的对比分析具有一定的临床价值。目的分析自发性早产不同高危因素的构成比，探讨不同孕周的自发性早产对妊娠结局的影响及自发性早产与未足月胎膜早破早产是否存在早产儿结局的不同。方法以2012年1月～2013年12月在郑州大学第三附属医院住院分娩的单胎自发性早产（SPB）患者为研究对象，从中选取200例按照不同孕周分为3组，A组为孕28～31+6周、B组为孕32～33+6周、C组为孕34～36+6周，同期选取未足月胎膜早破早产(PPROM)患者200例，进行临床资料的回顾性分析。结果（1）200例SPB最主要的高危因素为既往早产或反复流产史，其次为下生殖道感染、孕期先兆流产史等。（2）早期早产组新生儿窒息率、新生儿感染率、新生儿颅内出血率和新生儿肺透明膜病发生率明显高于中型早产组和轻型早产组，差异具有统计学意义。而三组之间的会阴侧切率和产后出血率无统计学差异。（3）SPB患者的新生儿感染率低于PPROM患者，新生儿肺透明膜病发生率高于PPROM患者，差异有统计学意义。而两者在新生儿出生体重、新生儿窒息率、新生儿颅内出血率等方面比较无统计学差异。结论（1）自发性早产最常见的高危因素为不良孕产史。（2）孕周与新生儿预后密切相关，自发性早产孕32周之前的新生儿窒息率和新生儿颅内出血率明显升高。（3）自发性早产与未足月胎膜早破早产存在早产儿结局的不同。更多还原

【Abstract】 Preterm birth refers to the gestation from28weeks to37weeks (196～258)delivery.Preterm delivery according to the reasons can be divided into spontaneouspreterm birth (SPB), Preterm prematurely ruptured membranes (PPROM) andIatrogenic preterm delivery (IPD).SPB is one of the most common types. It is theresult of many factors, like a history of premature birth, low degree of culture, noregularly prenatal, intrauterine infection.etc.Foreign studies have shown thatintrauterine infection can explain about40%of the preterm births occur, therefore,the proportion of different high risk factors of preterm births there may be differences.Gestational age is the main factor which influences the prognosis of premature birth.It has been pointed out that preterm birth at32weeks before has one of the mostcommon complications is neonatal respiratory distress syndrome (NRDS), and itsincidence and mortality were significantly higher than32weeks after. So seeking theclinical characteristics of different gestational ages in SPB is very important to guideclinical prevention works. Because of the chorioamnionitis plays an important role inthe pathogenesis of SPB and PPROM,before both were known as idiopathicpremature birth. Recently, premature rupture of membranes have been pointed outthat it is more likely to cause intrauterine infection, which results to the neonatalasphyxia, neonatal infections, etc.So separating the SPB and PPROM to research thedifferent outcomes of premature infant has a certain clinical value. ObjectiveTo analysis the different composition ratio of delivery high risks in spontaneouspremature birth, explore the pregnancy outcome in different gestational ages anddiscuss whether there is a difference between spontaneous preterm birth and Pretermprematurely ruptured membranes(PPROM) about the Premature infant outcome.MethodsThe clinical features of200singletons patients with spontaneous prematurebirth(SPB) from January2012to December2013was chosen, which was divided intothree groups according the gestational age.The preterm birth group which from28to31+6weeks was designed for group A, the group which from32to33+6weeks wasdesigned for group B,while the group which from34to36+6weeks was designed forgroup C.In the same period patients with preterm premature rupture of membranes(PPROM)in200cases was selected also.ResultsFirstly. The main dangerous factors of200patients with spontaneous pretermbirth is the history of preterm birth or recurrent abortion,followed by the genital TractInfection,the history of threatened abortion in the pregnancy period,etc.Secondly.Inearly preterm birth group of Patients has a high rate of neonatal asphyxia andintracranial hemorrhage,while the moderate preterm group and the light pretermgroup do not have any significant differences in them.Thirdly.The spontaneouspreterm birth patients compared with preterm prematurely ruptured membranes haveno difference in neonatal birth weight, neonatal asphyxia,neonatal intracranialhemorrhage,etc. The neonatal infection rate of SPB is lower than PPROM,while theneonatal pulmonary hyaline membrane disease incidence rate is higher. Thedifference has a statistical significance. ConclusionsFirstly. One of the most common risk factors for spontaneous preterm birth isthe history of recurrent miscarriage.Secondly.The Spontaneous preterm birth before32weeks has a high rate of neonatal asphyxia and neonatal intracranialhemorrhage.Thirdly.There is no significant difference of neonatal asphyxia betweenSpontaneous preterm birth and preterm premature rupture of membranes,while SPBhas a high rate of neonatal pulmonary hyaline membrane disease.更多还原