The analysis of risk factors and neonatal outcomes associated with histologic chorioamnionitis after preterm premature rupture of membranes / 中国医师进修杂志

ABSTRACT

Objective To investigate factors and neonatal outcomes associated with histologic chorioamnionitis(HCA) after preterm premature rupture of membranes (PPROM).Methods From January 2008 to January 2013,103 women with PPROM at 28-33+6 weeks of gestation undergoing deliveries were studied retrospectively.According to placental histopathologic findings,those patients were categorized into two groups,including 68 cases in histologic chorioamnionitis (HCA group) and 35 cases in non-chorioamnionitis (control group).Age,parity,gestational age of PPROM and delivery,latency period,oligohydramnios,white blood cell (WBC) count and serum C reactive protein (CRP) level at admission and before delivery,and the neonatal outcomes were compared between two groups.The risk factors were analyzed by multivariable Logistic regression analysis.Results The incidence of HCA was 66.0％ (68/103) in all cases with PPROM.The occurring ruptured membrane gestation in HCA group was (28.2 ± 1.2) weeks,which were significantly earlier than (32.3 ± 1.4) weeks in control group (P ＜ 0.05).The level of CRP of (8.3 ± 4.7) mg/L before dehvery in HCA group was significantly higher than (5.4 ± 3.2) mg/L in control group (P ＜ 0.05).The rates of oligohydramnios and cesarean sections were significantly higher than those in control group (P ＜0.01 or ＜0.05).Using multivariable Logistic regression analysis,oligohydramnios,gestational age of PPROM ＜ 32 weeks,serum CRP level ＞ 8 mg/L before delivery and latency period 48-168 h were significantly associated with HCA (P ＜ 0.01 or ＜ 0.05).The gestational age of delivery and birth weight of HCA group were significantly lower than those of control group (P ＜ 0.05).The incidence of Apgar ＜ 7 scores,abnormal brain ultrasonography findings,neonatal pneumonia,bronchopulmonary dysplasia,early-onset neonatal sepsis and mortality in HCA group were significantly higher than those in control group (P ＜ 0.05).Conclusions HCA has significantly correlated with lower gestational age of PPROM,higher serum CRP level before delivery,prolonged latency period and oligohydramnios in PPROM.HCA could increase the neonatal morbidity and mortality.