妊娠期糖尿病足月胎膜早破引产时机的探讨及其对母儿结局的影响
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南京医科大学生殖医学国家重点实验室

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]国家自然科学基金(面上项目)(81971410),国家重点研发计划(2022YFC2703503),江苏省重大疾病生物资源样本库出生队列子库开放课题,TC2021B024*通讯作者(Corresponding author),E-mail:jesse_1982@163.com


Study on the precise timing of oxytocin labor induction in GDM women with term premature rupture of membranes and its influence on pregnancy outcomes
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1.State Key Laboratory of Reproductive Medicine,Nanjing Medical University,Women'2.'3.s Hospital of Nanjing Medical University Nanjing Maternity and Child Health Care Hospital

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    摘要:

    目的:探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)足月胎膜早破(premature rupture of membrane,PROM)孕妇不同引产时机对母儿结局的影响。方法:回顾性分析南京市妇幼保健院2017年6月至2021年7月,除GDM以外无其他合并症及并发症的足月胎膜早破催产素引产的孕妇585例,根据胎膜早破(PROM)距离启动催产素(Oxytocin)引产的时间间隔(P-O)分为三组:A组(2~6h),B组(6~9h)和C组(9~12h)。对三组病例的一般临床资料、母儿主要结局进行统计学分析。结果:①胎膜早破(PROM)距离分娩(Delivery)的时间(P-D)随着引产启动时间(P-O)的延迟而增加(P trend<0.05),其中A组的P-D时间最短(P<0.05);②剖宫产、产间发热、绒毛膜羊膜炎、胎儿宫内窘迫的发生率会随着P-O的延长而升高(P trend<0.05),其中A组发生率最低(P<0.05);三组子宫收缩乏力、产后出血、产褥病率等发生率未见统计学差异;③三组产妇因子宫收缩乏力而剖宫产的发生率随着P-O的延迟而增加(P trend<0.05);④A组新生儿败血症的发病率、新生儿颅内出血的发生率显著低于C组(P<0.05)。结论:妊娠期糖尿病足月胎膜早破孕妇在无其他并发症且排除阴道分娩禁忌症情况下,选择2~6h内催产素引产,既可以减少临床抗菌素的使用,也可以显著降低母儿不良结局的发生率。

    Abstract:

    OBJECTIVE:To study the precise timing of labor induction in GDM women with term premature rupture of membranes and its influence on maternal and child outcomes.METHODS:A retrospective analysis was performed on 585 pregnancies with premature rupture of membranes at term without other comorbidity and complications except GDM in Nanjing Maternal and Child Health Hospital from June 2017 to July 2021, which were divided into three groups according to the time interval time (P-O) between preterm rupture of membranes and initiation of oxytocin induction:group A (2~6h),group B (6~9h),group C (9~12h).The general clinical data, maternal and neonatal primary outcomes of the cases in the three groups were statistically analyzed.RESULTS:①The time from premature rupture of membranes to delivery (P-D) increased with the delay of induction of labor initiation (P-O)(P trend<0.05),with the shortest P-D time in group A(P <0.05);②The incidence of cesarean delivery, fever,chorioamnionitis , and intrauterine distress increased with the prolongation of P-O(P trend<0.05),of which the incidence was the lowest in group A(P <0.05);no statistical difference was found in the incidence of uterine contraction weakness, postpartum hemorrhage, and puerperal disease in the three groups;③the incidence of cesarean delivery due to uterine contraction weakness increased with the delay of P-O in the three groups(P trend<0.05);④the incidence of neonatal sepsis and neonatal intracranial hemorrhage in group A was significantly lower than that in group C(P trend<0.05),incidence were significantly lower than those in group C(P<0.05).CONCLUSION:In pregnant women with GDM and PROM at term, to exclude other complications and contraindications to vaginal delivery, the choice of oxytocin induction of labor with in 2~6h can both reduce the use of clinical antimicrobials and significantly reduce the incidence of adverse maternal and pediatric outcomes.

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  • 收稿日期:2022-12-08
  • 最后修改日期:2023-02-04
  • 录用日期:2023-05-10
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