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目的评估20~23~(+6)周胎膜早破的发生率、预后以及各类并发症的发生概率。方法选取2012年1月-2015年12月嘉兴市妇幼保健院诊治的孕20~23~(+6)周胎膜早破,并选择期待治疗的孕产妇,对其临床资料进行回顾性研究。结果在156例患者中,35例(22.4%)新生儿存活至出院为存活组,其余为死亡组。存活组发病孕周为(23.0±0.8)周,较死亡组晚(P<0.001),期待治疗时间更长,为(21.9±20.5)d,终止妊娠孕周更晚,为(27.1±2.6)周(P均<0.001)。在母体并发症方面,总体的绒毛膜羊膜炎发生率为41.7%,胎盘早剥发生率为16.0%,败血症发生率为4.5%(P>0.05)。在存活的新生儿中,有17例发生了严重的并发症,占48.6%,主要为支气管肺发育不良7例(20.0%),严重神经系统损伤11例(31.4%),癫痫1例(2.9%),坏死性小肠结肠炎2例(5.7%),败血症5例(14.3%),早产儿视网膜病变3期及以上4例(11.4%)。121例新生儿死亡原因经过统计主要由于以下并发症的发生:极早早产97例(81.2%),呼吸衰竭48例(39.7%),新生儿败血症42例(34.7%),严重脑室内出血24例(19.8%)以及坏死性小肠结肠炎16例(13.2%)。结论对于20~23~(+6)周间发生的胎膜早破应尽快终止妊娠,以免引起母体各类严重并发症的发生。
Objective To evaluate the incidence of premature rupture of membranes, its prognosis and the incidence of various complications in 20 ~ 23 ~ (+6) weeks. Methods Premature rupture of membranes in 20 ~ 23 ~ (+6) weeks of pregnancy diagnosed and treated in Jiaxing Maternal and Child Health Hospital from January 2012 to December 2015 was selected. The expectant mothers who were expecting treatment were selected and their clinical data were retrospectively studied. Results Of the 156 patients, 35 (22.4%) newborns survived until they were discharged as survivors and the rest as deaths. The gestational age of the survivors was (23.0 ± 0.8) weeks, which was later than that of the death group (P <0.001). The duration of expectant treatment was (21.9 ± 20.5) d and the gestational age was later (27.1 ± 2.6) Week (P <0.001). In maternal complications, the overall incidence of chorioamnionitis was 41.7%, the incidence of placental abruption was 16.0%, and the incidence of sepsis was 4.5% (P> 0.05). Of the surviving newborns, 17 had severe complications (48.6%), mainly bronchopulmonary dysplasia in 7 (20.0%), severe neurological injury in 11 (31.4%) and epilepsy in 1 (2.9%) ), Necrotizing enterocolitis in 2 (5.7%), sepsis in 5 (14.3%) and preterm retinopathy in 3 and above (11.4%). 121 cases of neonatal mortality statistics mainly due to the occurrence of the following complications: early very early 97 cases (81.2%), respiratory failure in 48 cases (39.7%), neonatal sepsis in 42 cases (34.7%), severe intraventricular hemorrhage in 24 cases (19.8%) and necrotizing enterocolitis in 16 cases (13.2%). Conclusion For premature rupture of membranes between 20 ~ 23 ~ (+6) weeks, pregnancy should be terminated as soon as possible so as not to cause all kinds of serious complications of maternal.