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目的:分析妊娠32~34周胎膜早破的临床处理及母儿预后,寻找最佳终止妊娠时机。方法:回顾性分析妊娠32~34周胎膜早破92例,比较保胎组与不保胎组胎膜早破距分娩的时间(潜伏期)、母儿并发症及早产儿不良预后间差别;并对分娩前使用地塞米松促胎肺成熟时限及新生儿出生体重与早产儿预后的关系进行统计学分析。结果:①保胎组胎膜早破潜伏期明显长于不保胎组,早产儿感染性疾病的发生率高于不保胎组;早产儿呼吸窘迫综合征(NRDS)发生率低于不保胎组;孕妇感染、胎盘绒毛膜羊膜炎及剖宫产发生率明显高于不保胎组,差异有统计学意义(P<0.05)。早产儿不良预后(死亡、转院及自动出院)发生率两组无明显差异(P>0.05);②地塞米松促胎肺成熟治疗48 h后,NRDS及早产儿不良预后发生率低于用药时间不足48 h者,差异有显著性(P<0.05);③孕周32~34周胎膜早破新生儿体重≥2 000 g者NRDS及不良预后发生率低于新生儿体重<2 000 g者,差异有统计学意义(P<0.05)。结论:对于妊娠32~34周胎膜早破的孕妇,在促胎肺成熟后、估计胎儿体重>2 000 g,不宜盲目保胎,尽早终止妊娠可避免母儿不良并发症发生。
Objective: To analyze the clinical treatment of premature rupture of membranes and the prognosis of maternal and child in 32-34 weeks of gestation and find out the optimal timing of termination of pregnancy. Methods: A retrospective analysis of 92 to 34 weeks of premature rupture of membranes in 92 cases of premature rupture of membranes between unlabelled and unprotected groups was compared with that of premature rupture of childbirth (maladjustment), maternal complications and poor prognosis of preterm infants. The use of dexamethasone before delivery to promote fetal lung maturity and neonatal birth weight and prognosis of preterm children were statistically analyzed. Results: ① The latent period of premature rupture of membranes in TCB group was significantly longer than that in LCB group, and the incidence of infectious diseases in premature infants was higher than that in LCB group. The incidence of respiratory distress syndrome (NRDS) The incidence of pregnant women infection, placental chorioamnionitis and cesarean section were significantly higher than that of unprotected fetus group, the difference was statistically significant (P <0.05). The incidence of adverse outcomes in preterm infants (death, transfer and discharge) had no significant difference between the two groups (P> 0.05). ② After dexamethasone for 48 hours, the incidence of adverse outcomes in NRDS and premature infants was lower than that in medication 48h, the difference was significant (P <0.05); ③ gestational weeks 32 to 34 weeks of premature rupture of membranes in neonates with weight ≥ 2000 g of NRDS and adverse prognosis than neonatal body weight <2000 g, The difference was statistically significant (P <0.05). Conclusion: For preterm premature rupture of membranes in pregnant women with 32-34 weeks of gestation, it is estimated that fetus weight> 2000 g after promoting fetal lung maturity. It is not advisable to blindly keep the fetus. Termination of pregnancy as soon as possible can prevent the occurrence of maternal and neonatal complications.