The management of preterm prelabor rupture of membranes (PPROM) before 34 weeks of gestation is intractable, due to pulmonary immaturity, many complications, poor pregnancy outcomes. In particular, the pre-viable PPRO...The management of preterm prelabor rupture of membranes (PPROM) before 34 weeks of gestation is intractable, due to pulmonary immaturity, many complications, poor pregnancy outcomes. In particular, the pre-viable PPROM (<23 weeks of gestation) is much more difficult to be treated. The clinical recommendation is to terminate the pregnancy as soon as possible. The pregnancy outcomes of PPROM in the early second-trimester of two twin pregnant women in our hospital were reported to explore the treatment protocols. The pregnancies of the two women developed PROM at 12 and 16 weeks of gestation, respectively. After expectant treatment, they were deliveried successfully at 34+6 and 34+4 weeks of gestation, respectively. The assessment of growth and development of infants was normal during the following six months after birth. Therefore, if PPROM occurs in the early second-trimester of pregnancy, the management of PPROM should be individualized, it’s a long process which should include comprehensive communication between patients and families regarding alternative treatment options (including expectant management) and risks and benefits of the procedure. In the absence of spontaneous labor or occurrence of complications that would prompt delivery (intra-amniotic infection, abruptio placenta, cord prolapse), and fetal status is normal, the patients should proceed with expectant treatment, induction of labor is commonly performed in pregnancies with PPROM ≥34 weeks of gestation.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Preterm prelabor ruptur...<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Preterm prelabor rupture of membranes (PPROM) is a major cause of Pretem Birth (PTB), Pretem Birth (PTB) is the most significant cause of perinatal morbidity and mortality worldwide. Cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) have been postulated in several studies to have an important role in prediction of PTB. Up to our knowledge, this is the first study that combines the three cervical parameters in prediction of latency period in women with PPROM. </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Aim</span></b></span></span><span><span><span style="font-family:""> <b><span style="font-family:Verdana;">of</span></b> <b><span style="font-family:Verdana;">the</span></b> <b><span style="font-family:Verdana;">Work:</span></b> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">To assess the accuracy of cervical length, posterior uterocervical angle and anterior uterocervical angle in prediction of latency period in women with Preterm prelabor rupture of membranes. </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Subjects</span></b></span></span><span><span><span style="font-family:""> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Prospective cohort study</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> on </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">205 women with PPROM </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">was held </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">at Ain Shams University Maternity Hospital</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> a transvaginal ultrasound was performed to measure cervical length, posterior uterocervical angle, anterior uterocervical angle. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> A total of 205 pregnant women with PPROM were included in this study, the latency grade was within 2 days in 57 (27.8%) of cases while was after 2 days in 148 (72.2%) of cases. As regards cervical length cut-off value 25.0 mm, sensitivity was 78.9%, specificity was 65.5%, posterior uterocervical angle cut-off value 108.0<span style="white-space:nowrap;">°</span>, sensitivity was 93.0%, specificity was 60.1%, and anterior uterocervical angle cut-off value 106.0<span style="white-space:nowrap;">°</span>, sensitivity was 93.0%, specificity was 71.6%. </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion:</span></b></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The combination of cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) measurements greatly predict</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> the latency period in women with PPROM, and Anterior </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">uterocervical angle (AUCA) ≥ 106.0<span style="white-space:nowrap;">°</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> had </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">highest diagnostic value</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">in predicting latency period within two days.</span></span></span>展开更多
Purpose: Neonatal pneumonia is a major newborn disease with a high morbidity rate. We aimed to evaluate whether atypical prelabor rupture of membranes (PROM) is a high-risk factor for causing neonatal pneumonia in a p...Purpose: Neonatal pneumonia is a major newborn disease with a high morbidity rate. We aimed to evaluate whether atypical prelabor rupture of membranes (PROM) is a high-risk factor for causing neonatal pneumonia in a prospective real-world study. Patients and Methods: A total of 250 pregnant women at pregnancy week 39 were non-selectively recruited. All were examined by PROM and neonatal pneumonia related clinical, bedside and lab tests, including body temperature, blood pressure, increased vagina discharge, posterior vault pooling, abdominal tenderness, WBC count, nitrazine test, amniotic fluid index, Leakection (a sICAM-1 based lateral flow immunoassay) and vagina streptococcus examinations. Increased vagina discharge with a Leakection positivity was adopted as a working criterium for identifying atypical PROM. Neonatal pneumonia was diagnosed based on the clinical presentation and lab tests. Results: Twenty cases of neonatal pneumonia (8.0%) were diagnosed after the deliveries of the 250 pregnant women. In these neonatal pneumonia cases, 12 (16.7%) occurred in 72 deliveries with atypical PROM, 2 (16.7%) in 12 deliveries with typical PROM, and 6 (3.6%) in 166 deliveries with non-PROM. Conclusion: In this real-world study, we find that a systematic screening at pregnancy week 39 was very meaningful in revealing atypical PROM. Moreover, atypical PROM is a major risk factor for neonatal pneumonia. Therefore, an early diagnosis and intervention on atypical PROM could potentially reduce the occurrence of neonatal pneumonia.展开更多
目的探讨胎膜早破(prelabor rupture of membranes,PROM)极早产儿的临床特征及其发生早发型败血症(early-onset sepsis,EOS)和死亡的预测因素。方法回顾性收集2018年1月至2020年5月入住新生儿重症监护室的PROM极早产儿(胎龄<32周)的...目的探讨胎膜早破(prelabor rupture of membranes,PROM)极早产儿的临床特征及其发生早发型败血症(early-onset sepsis,EOS)和死亡的预测因素。方法回顾性收集2018年1月至2020年5月入住新生儿重症监护室的PROM极早产儿(胎龄<32周)的临床资料。根据胎膜破裂至分娩的时间不同分为4组:PROM<18 h(107例)、PROM 18 h~<3 d (111例)、PROM 3 d~<14 d (144例)和PROM≥14 d (37例);根据是否发生EOS分为EOS组(42例)和非EOS组(357例);根据是否存活分为存活组(359例)和死亡组(40例)。分析不同PROM时间极早产儿的临床特征,并采用多因素logistic回归分析PROM极早产儿发生EOS和死亡的预测因素。结果不同PROM时间极早产儿新生儿期主要并发症发生率和病死率差异无统计学意义(P>0.05)。出生体重<1 000 g (OR=4.353,P=0.042)、Ⅲ度羊水污染(OR=4.132,P=0.032)及Ⅲ~Ⅳ级呼吸窘迫综合征(OR=2.528,P=0.021)是PROM极早产儿发生EOS的预测因素。较低的出生体重(<1 000 g或1 000~1 499 g;OR分别为11.267、3.456,P分别为0.004、0.050)、Ⅲ~Ⅳ级呼吸窘迫综合征(OR=5.572,P<0.001)和新生儿败血症(OR=2.631,P=0.012)是PROM极早产儿死亡的预测因素。结论 PROM时间延长不增加极早产儿新生儿期并发症的发生率和病死率。PROM极早产儿的主要不良结局与较低的出生体重、肺发育不成熟和全身感染密切相关。[中国当代儿科杂志,2021,23 (6):575-581]展开更多
目的:探究妊娠合并糖尿病对未足月胎膜早破(PROM)发生率及母婴结局的影响。方法:选取2018年6月—2022年6月于福州福兴妇产医院就诊的糖代谢异常孕产妇400例作为研究组,同期选取于福兴妇产医院行产前检查的糖代谢正常孕产妇400例作为对...目的:探究妊娠合并糖尿病对未足月胎膜早破(PROM)发生率及母婴结局的影响。方法:选取2018年6月—2022年6月于福州福兴妇产医院就诊的糖代谢异常孕产妇400例作为研究组,同期选取于福兴妇产医院行产前检查的糖代谢正常孕产妇400例作为对照组。均行血糖检测,比较两组未足月PROM发生率、母婴结局及妊娠合并糖尿病指标与母婴妊娠结局的相关性。结果:研究组孕产妇未足月PROM发生率为20.5%,显著高于对照组的3.0%,差异有统计学意义(P<0.05);研究组产妇早产、剖宫产、羊水过多、产后出血、妊娠期高血压疾病发生率均明显高于对照组,差异有统计学意义(P<0.05);研究组新生儿发生新生儿窒息、新生儿低血糖、高胆红素血症、新生儿呼吸窘迫综合征(NRDS)、巨大儿及围生儿死亡的比例显著高于对照组,差异有统计学意义(P<0.05);空腹血糖(FPG)、餐后2 h血糖(2 h PG)及糖化血红蛋白(HbA1c)与糖代谢异常孕产妇早产、产后出血、妊娠期高血压综合征呈显著正相关性(r>0,P<0.05),FPG、2 h PG及HbA1c与新生儿窒息、巨大儿、NRDS、新生儿低血糖、高胆红素血症呈显著正相关性(r>0,P<0.05)。结论:孕产妇糖代谢异常会增加未足月PROM发生率,糖代谢异常孕产妇妊娠期高血压疾病、新生儿出现巨大儿发生率仍较高,且糖尿病相关指标与母婴部分结局密切相关,需重视并加强妊娠合并糖尿病的诊断与治疗,降低未足月PROM发生率及母婴并发症,从而降低妊娠风险。展开更多
目的探讨声诱发反应(acoustic stimulation test,AST)在胎膜早破(prelabor rupture of membranes,PROM)胎儿听力监测中的可行性。方法选取2018年6月—2021年12月宁德师范学院附属宁德市医院妇产科收治的2725例PROM孕妇作为PROM组,根据P...目的探讨声诱发反应(acoustic stimulation test,AST)在胎膜早破(prelabor rupture of membranes,PROM)胎儿听力监测中的可行性。方法选取2018年6月—2021年12月宁德师范学院附属宁德市医院妇产科收治的2725例PROM孕妇作为PROM组,根据PROM发生时阴道分泌物病原体检测结果分为生殖道感染(reproductive tract infections,RTI)组(阳性)918例和无RTI组(阴性)1807例;再根据胎龄进一步划分为足月组(孕期≥37周)1792例和早产组(28周≤孕期<37周)933例,为以上受试者行AST检测和新生儿听力筛查及诊断。同时,选取无PROM受试者600例作为对照组,最后将各组结果进行对比。结果RTI组足儿和早产儿的AST阳性率均明显低于无RTI组和对照组,差异有统计学意义(P<0.05);3月龄时,PROM组足月儿和早产儿的声导抗和畸变产物耳声发射(DPOAE)与对照组比较,差异无统计学意义(P>0.05),但其V波阈值明显高于无PROM组;6月龄时,PROM组足月儿和早产儿的声导抗、DPOAE及V波阈值与对照组比较,差异均无统计学意义(P>0.05);在听力损失随访幼儿中,起初超过一半患儿的声导抗异常,而DPOAE通过率低、V波阈值差。随着月龄增加,各组患儿(PROM组足月儿除外)的声导抗异常率、DPOAE通过率及V波阈值均出现明显改善;在阳性AST,PROM组及对照组患儿听力损失多为轻、中度;在阴性AST,PROM组患儿听力损失多为单或双耳中、重度,而对照组则多为同时双耳;AST对筛查胎儿听力损失的曲线下面积(Area under the curve,AUC)为0.821,联合DPOAE的AUC则为0.915,高于单独使用AST或DPOAE,对重度和极重度者具有很好的敏感度。结论AST可以较好地反映与预估PROM宫内胎儿听力,可供临床选择/联合使用;尤其是RTI阴性者,其听力损失率较高,应加强此类患儿的听力跟踪与随访。展开更多
胎膜早破(prelabor rupture of membranes,PROM)被定义为临产前发生胎膜破裂。其中,妊娠37周之前发生的PROM被称为未足月胎膜早破(preterm PROM,PPROM)。2020年美国妇产科医师学会(American College of Obstetricians and Gynecologists...胎膜早破(prelabor rupture of membranes,PROM)被定义为临产前发生胎膜破裂。其中,妊娠37周之前发生的PROM被称为未足月胎膜早破(preterm PROM,PPROM)。2020年美国妇产科医师学会(American College of Obstetricians and Gynecologists,ACOG)发布了"胎膜早破临床实践指南(2020)",是在2018年版本指南基础上的完善补充,主要更新了以下方面:PROM的诊断、足月PROM的期待疗法、妊娠34~36+6周PPROM孕妇分娩时机[1]。旨在为PROM孕妇的管理提供基于研究和专家意见的建议。展开更多
胎膜破裂发生在临产前称胎膜早破,发生在妊娠37周前称未足月胎膜早破(preterm prelabor rupture of membranes,PPROM)。在美国,未足月胎膜早破发生率为2%~4%,其中<34孕周胎膜早破约占1%,34~36+6孕周胎膜早破占2%~3%。PPROM对母儿预...胎膜破裂发生在临产前称胎膜早破,发生在妊娠37周前称未足月胎膜早破(preterm prelabor rupture of membranes,PPROM)。在美国,未足月胎膜早破发生率为2%~4%,其中<34孕周胎膜早破约占1%,34~36+6孕周胎膜早破占2%~3%。PPROM对母儿预后有不良影响,最主要的并发症是早产和感染:PPROM是早产的重要原因。展开更多
基金National Key Research and Development Program of China(No. 2018YFC1002900)National Natural Science Foundation of China(No. 81671527)。
文摘The management of preterm prelabor rupture of membranes (PPROM) before 34 weeks of gestation is intractable, due to pulmonary immaturity, many complications, poor pregnancy outcomes. In particular, the pre-viable PPROM (<23 weeks of gestation) is much more difficult to be treated. The clinical recommendation is to terminate the pregnancy as soon as possible. The pregnancy outcomes of PPROM in the early second-trimester of two twin pregnant women in our hospital were reported to explore the treatment protocols. The pregnancies of the two women developed PROM at 12 and 16 weeks of gestation, respectively. After expectant treatment, they were deliveried successfully at 34+6 and 34+4 weeks of gestation, respectively. The assessment of growth and development of infants was normal during the following six months after birth. Therefore, if PPROM occurs in the early second-trimester of pregnancy, the management of PPROM should be individualized, it’s a long process which should include comprehensive communication between patients and families regarding alternative treatment options (including expectant management) and risks and benefits of the procedure. In the absence of spontaneous labor or occurrence of complications that would prompt delivery (intra-amniotic infection, abruptio placenta, cord prolapse), and fetal status is normal, the patients should proceed with expectant treatment, induction of labor is commonly performed in pregnancies with PPROM ≥34 weeks of gestation.
文摘<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Preterm prelabor rupture of membranes (PPROM) is a major cause of Pretem Birth (PTB), Pretem Birth (PTB) is the most significant cause of perinatal morbidity and mortality worldwide. Cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) have been postulated in several studies to have an important role in prediction of PTB. Up to our knowledge, this is the first study that combines the three cervical parameters in prediction of latency period in women with PPROM. </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Aim</span></b></span></span><span><span><span style="font-family:""> <b><span style="font-family:Verdana;">of</span></b> <b><span style="font-family:Verdana;">the</span></b> <b><span style="font-family:Verdana;">Work:</span></b> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">To assess the accuracy of cervical length, posterior uterocervical angle and anterior uterocervical angle in prediction of latency period in women with Preterm prelabor rupture of membranes. </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Subjects</span></b></span></span><span><span><span style="font-family:""> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Prospective cohort study</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> on </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">205 women with PPROM </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">was held </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">at Ain Shams University Maternity Hospital</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> a transvaginal ultrasound was performed to measure cervical length, posterior uterocervical angle, anterior uterocervical angle. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> A total of 205 pregnant women with PPROM were included in this study, the latency grade was within 2 days in 57 (27.8%) of cases while was after 2 days in 148 (72.2%) of cases. As regards cervical length cut-off value 25.0 mm, sensitivity was 78.9%, specificity was 65.5%, posterior uterocervical angle cut-off value 108.0<span style="white-space:nowrap;">°</span>, sensitivity was 93.0%, specificity was 60.1%, and anterior uterocervical angle cut-off value 106.0<span style="white-space:nowrap;">°</span>, sensitivity was 93.0%, specificity was 71.6%. </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion:</span></b></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The combination of cervical length (CL), posterior uterocervical angle (PUCA) and anterior uterocervical angle (AUCA) measurements greatly predict</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> the latency period in women with PPROM, and Anterior </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">uterocervical angle (AUCA) ≥ 106.0<span style="white-space:nowrap;">°</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> had </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">highest diagnostic value</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">in predicting latency period within two days.</span></span></span>
文摘Purpose: Neonatal pneumonia is a major newborn disease with a high morbidity rate. We aimed to evaluate whether atypical prelabor rupture of membranes (PROM) is a high-risk factor for causing neonatal pneumonia in a prospective real-world study. Patients and Methods: A total of 250 pregnant women at pregnancy week 39 were non-selectively recruited. All were examined by PROM and neonatal pneumonia related clinical, bedside and lab tests, including body temperature, blood pressure, increased vagina discharge, posterior vault pooling, abdominal tenderness, WBC count, nitrazine test, amniotic fluid index, Leakection (a sICAM-1 based lateral flow immunoassay) and vagina streptococcus examinations. Increased vagina discharge with a Leakection positivity was adopted as a working criterium for identifying atypical PROM. Neonatal pneumonia was diagnosed based on the clinical presentation and lab tests. Results: Twenty cases of neonatal pneumonia (8.0%) were diagnosed after the deliveries of the 250 pregnant women. In these neonatal pneumonia cases, 12 (16.7%) occurred in 72 deliveries with atypical PROM, 2 (16.7%) in 12 deliveries with typical PROM, and 6 (3.6%) in 166 deliveries with non-PROM. Conclusion: In this real-world study, we find that a systematic screening at pregnancy week 39 was very meaningful in revealing atypical PROM. Moreover, atypical PROM is a major risk factor for neonatal pneumonia. Therefore, an early diagnosis and intervention on atypical PROM could potentially reduce the occurrence of neonatal pneumonia.
文摘目的:探究妊娠合并糖尿病对未足月胎膜早破(PROM)发生率及母婴结局的影响。方法:选取2018年6月—2022年6月于福州福兴妇产医院就诊的糖代谢异常孕产妇400例作为研究组,同期选取于福兴妇产医院行产前检查的糖代谢正常孕产妇400例作为对照组。均行血糖检测,比较两组未足月PROM发生率、母婴结局及妊娠合并糖尿病指标与母婴妊娠结局的相关性。结果:研究组孕产妇未足月PROM发生率为20.5%,显著高于对照组的3.0%,差异有统计学意义(P<0.05);研究组产妇早产、剖宫产、羊水过多、产后出血、妊娠期高血压疾病发生率均明显高于对照组,差异有统计学意义(P<0.05);研究组新生儿发生新生儿窒息、新生儿低血糖、高胆红素血症、新生儿呼吸窘迫综合征(NRDS)、巨大儿及围生儿死亡的比例显著高于对照组,差异有统计学意义(P<0.05);空腹血糖(FPG)、餐后2 h血糖(2 h PG)及糖化血红蛋白(HbA1c)与糖代谢异常孕产妇早产、产后出血、妊娠期高血压综合征呈显著正相关性(r>0,P<0.05),FPG、2 h PG及HbA1c与新生儿窒息、巨大儿、NRDS、新生儿低血糖、高胆红素血症呈显著正相关性(r>0,P<0.05)。结论:孕产妇糖代谢异常会增加未足月PROM发生率,糖代谢异常孕产妇妊娠期高血压疾病、新生儿出现巨大儿发生率仍较高,且糖尿病相关指标与母婴部分结局密切相关,需重视并加强妊娠合并糖尿病的诊断与治疗,降低未足月PROM发生率及母婴并发症,从而降低妊娠风险。
文摘目的探讨声诱发反应(acoustic stimulation test,AST)在胎膜早破(prelabor rupture of membranes,PROM)胎儿听力监测中的可行性。方法选取2018年6月—2021年12月宁德师范学院附属宁德市医院妇产科收治的2725例PROM孕妇作为PROM组,根据PROM发生时阴道分泌物病原体检测结果分为生殖道感染(reproductive tract infections,RTI)组(阳性)918例和无RTI组(阴性)1807例;再根据胎龄进一步划分为足月组(孕期≥37周)1792例和早产组(28周≤孕期<37周)933例,为以上受试者行AST检测和新生儿听力筛查及诊断。同时,选取无PROM受试者600例作为对照组,最后将各组结果进行对比。结果RTI组足儿和早产儿的AST阳性率均明显低于无RTI组和对照组,差异有统计学意义(P<0.05);3月龄时,PROM组足月儿和早产儿的声导抗和畸变产物耳声发射(DPOAE)与对照组比较,差异无统计学意义(P>0.05),但其V波阈值明显高于无PROM组;6月龄时,PROM组足月儿和早产儿的声导抗、DPOAE及V波阈值与对照组比较,差异均无统计学意义(P>0.05);在听力损失随访幼儿中,起初超过一半患儿的声导抗异常,而DPOAE通过率低、V波阈值差。随着月龄增加,各组患儿(PROM组足月儿除外)的声导抗异常率、DPOAE通过率及V波阈值均出现明显改善;在阳性AST,PROM组及对照组患儿听力损失多为轻、中度;在阴性AST,PROM组患儿听力损失多为单或双耳中、重度,而对照组则多为同时双耳;AST对筛查胎儿听力损失的曲线下面积(Area under the curve,AUC)为0.821,联合DPOAE的AUC则为0.915,高于单独使用AST或DPOAE,对重度和极重度者具有很好的敏感度。结论AST可以较好地反映与预估PROM宫内胎儿听力,可供临床选择/联合使用;尤其是RTI阴性者,其听力损失率较高,应加强此类患儿的听力跟踪与随访。
文摘胎膜早破(prelabor rupture of membranes,PROM)被定义为临产前发生胎膜破裂。其中,妊娠37周之前发生的PROM被称为未足月胎膜早破(preterm PROM,PPROM)。2020年美国妇产科医师学会(American College of Obstetricians and Gynecologists,ACOG)发布了"胎膜早破临床实践指南(2020)",是在2018年版本指南基础上的完善补充,主要更新了以下方面:PROM的诊断、足月PROM的期待疗法、妊娠34~36+6周PPROM孕妇分娩时机[1]。旨在为PROM孕妇的管理提供基于研究和专家意见的建议。
文摘胎膜破裂发生在临产前称胎膜早破,发生在妊娠37周前称未足月胎膜早破(preterm prelabor rupture of membranes,PPROM)。在美国,未足月胎膜早破发生率为2%~4%,其中<34孕周胎膜早破约占1%,34~36+6孕周胎膜早破占2%~3%。PPROM对母儿预后有不良影响,最主要的并发症是早产和感染:PPROM是早产的重要原因。
