臀先露、肩先露未足月胎膜早破对妊娠结局的影响

摘要

目的：探讨臀先露、肩先露未足月胎膜早破（PPROM）与妊娠结局间的关系，为临床处理PPROM提供参考。方法：收集单胎PPROM产妇235例，其中臀先露、肩先露并PPROM 49例，头先露PPROM 186例。观察两种类型PPROM的并发症及妊娠结局情况。结果：臀先露、肩先露组的潜伏期明显短于头先露组，其余一般情况与头先露组比较差异无统计学意义（P>0.05）。臀先露、肩先露组AFI≤5 cm、1 min Apgar评分≤7、脐带脱垂、死胎死产、新生儿死亡的比例明显高于头先露组（P<0.05）。臀先露、肩先露是导致1 min Apgar评分降低的独立危险因素（P=0.021，OR=0.0821）。臀位、横位先露组与头先露组的剖宫产率、阴道分娩率比较差异有统计学意义（P=0.00）。臀先露、肩先露的产妇中行剖宫产者脐带脱垂、死胎死产发生率明显低于阴道分娩。结论：臀先露、肩先露PPROM更容易发生脐带脱垂、1min Apgar评分≤7、AFI≤5 cm、死胎死产，是1 min Apgar低评分的独立危险因素，因此一旦确诊为PPROM，且胎位为臀先露、肩先露，应给予及时处理，避免脐带受压，尽快行剖宫产，有利于改善围产儿结局。%Objective:To investigate the relationship between PPROM with breech presentation,shoulder presentation and pregnancy outcome,to provide reference for clinical treatment of PPROM.Method:235 cases of single fetal PPROM maternal were collected.There were 49 cases in breech presentation,shoulder presentation PPROM,there were 186 cases in cephalic presentation PPROM.The complications and pregnancy outcome of two types of PPROM were observed.Result:The incubation period of breech presentation,shoulder presentation group were significantly shorter than that of cephalic presentation group.The rest of general situation of breech presentation,shoulder presentation group had no significant difference from cephalic presentation group(P>0.05).The rate of AFI ≤ 5 cm,1 min Apgar score≤7,umbilical cordprolapse,stillbirth,neonataldeath in breech presentation,shoulder presentation group were significantly higher than those of cephalic presentation group(P<0.05).Breech presentation,shoulder presentation was independent risk factors resulted from one minute Apgar score(P=0.021,OR=0.0821). The cesarean section rate and vaginal delivery rate was statistically significant between breech presentation,shoulder presentation group and cephalic presentationrate group(P=0.00).In breech presentation,shoulder presentation group,the umbilical cord,stillbirth incidence of cesarean section maternals was significantly lower than that of vaginal delivery maternals. Conclusion:Breech presentation,shoulder presentation PPROM is more prone to prolapse of umbilical cord,1 minute Apgar score≤7,AFI≤5 cm,stillbirth,neonatal death,it is independent risk factors of 1 minute low Apgar score,so once PPROM is diagnosed with breech presentation,shoulder presentation,timely treatment given,to avoid umbilical cord compressed,and cesarean section should be carried out to improve perinatal outcome.