足月妊娠胎膜早破孕妇不同时间引产的效果观察

唐婷

[摘要] 目的 探讨足月妊娠胎膜早破孕妇不同时间引产的效果。 方法 回顾性分析足月妊娠胎膜早破且使用缩宫素引产孕妇215例，根据不同时间引产将孕妇分为四组，A组（破膜后≤6 h缩宫素引产）56例、B组（破膜后7～12 h缩宫素引产）54例、C组（破膜后13～24 h缩宫素引产）53例、D组（破膜后>24 h缩宫素引产）52例，比较引产效果。结果 随着引产时间延长，顺产率、引产成功率和用药时宫颈Bishop 评分逐渐降低，其中D组上述指标明显低于A、B、C三组，组间比较差异有统计学意义（P<0.05）；随着引产时间延长，剖宫产率、母婴并发症发生率、用药至临产时间、破膜至分娩时间和产程时间逐渐增加，其中D组上述指标明显高于A、B、C三组，组间比较差异有统计学意义（P<0.05）。 结论 足月妊娠胎膜早破孕妇的不同时间引产效果差异显著，其中破膜后24 h内引产有助于提高引产成功率，降低剖宫产率和母婴并发症，减少临产、分娩及其产程时间。

[关键词] 足月妊娠；胎膜早破；引产；宫缩素；产程

[中图分类号] R719.3 [文献标识码] B [文章编号] 1673-9701（2016）25-0051-03

The effect observation of different induction time for uterogestation pregnancy premature rupture of membranes

TANG Ting

Department of Obstetics and Gynaecology， Ganzhou Municipal Hospital in Jiangxi Province， Ganzhou 341000， China

[Abstract] Objective To investigate the effect of different induction time for uterogestation pregnancy premature rupture of membranes（PROM）. Methods A total of 215 cases of uterogestation pregnancy PROM were retrospectively analyzed， according to different induction time were divided into four groups， group A（after rupture membranes≤6 h oxytocin， n=56）， group B（after membrane rupture 7-12 h oxytocin， n=54）， group C（after membrane rupture 13-24 h oxytocin， n=53）， group D（after membranes rupture >24 h oxytocin， n=52）， induction effects were compared among four groups. Results With induction time prolonged， the vaginal delivery rate， induced success rate and medication cervical Bishop score were decreased gradually， and there was significantly lower in group D than that in group A， group B and group C， it was significantly different among four groups（P<0.05）. With induction time prolonged， cesarean section rate， maternal complications， time of medication to parturient， time of membranes rupture to delivery and time of birth process were gradually increased， and it was significantly higher in group D than those in groups A， groups B and groups C， it was significantly different among four groups（P<0.05）. Conclusion The effect of different induction time for uterogestation pregnancy premature rupture of membranes is significantly different， the induction time which after membranes rupture within 24 h is helpful to improve induced success rate， reduce cesarean section rate and maternal complications， and decrease time of parturient， delivery and birth process.

[Key words] Uterogestation pregnancy； Premature rupture of membranes； Induction； Contractions； Labor

胎膜早破容易导致围产新生儿病死、早产、宫内感染和产后感染发生风险，严重威胁母婴健康。目前对于足月妊娠胎膜早破尚未有统一的临床处理方案[1]。部分研究表明，足月妊娠胎膜早破应等待自然临产，而部分研究证实引产可提高母婴安全[2]。本研究旨在探讨足月妊娠胎膜早破孕妇不同时间引产的效果，现报道如下。

1 资料与方法

1.1一般资料

回顾性分析足月妊娠胎膜早破引产孕妇215例，纳入标准：孕妇年龄24～35岁，孕周37～41周，胎儿体重≥2.5 kg，胎位为头先露，符合胎膜早破的诊断标准[3]，即大量阴道流液而无腹痛，阴道窥器见阴道后穹窿羊水积聚并从子宫口流出，阴道液干燥片检查见羊齿状结晶，石蕊试纸测定羊水偏碱性。排除标准：多胎妊娠、自然临产、剖宫产史、产科并发症、绝对性头盆不称、残余羊水指数<5 cm、宫内感染和胎儿宫内窘迫等。根据不同时间引……