早产胎膜早破后残余羊水量与母儿预后的关系
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摘要
目的:探讨早产胎膜早破(PPROM)后残余羊水量与母儿预后的关系。
方法:收集145例孕周在28-34周的PPROM患者,并根据破膜后的残余羊水指数(AFI)值将患者分为3组:(1)羊水过少组(AFI<50mm);(2)羊水偏少组(50mm≤AFI<80mm);(3)羊水正常组(80mm≤AFI<180mm)。比较三组间患者一般资料、新生儿体重、临床羊膜腔感染、剖宫产、胎盘早剥、胎儿窘迫、新生儿窒息、新生儿早发败血症、新生儿吸入性肺炎、新生儿呼吸窘迫综合征(NRDS)、新生儿黄疸、新生儿低血糖、新生儿缺氧缺血性脑病(HIE)、新生儿呼吸衰竭(RF)以及新生儿脑室内出血(IVH)等母儿发病发生率的差异。
结果:三组间的患者年龄、孕产次、发热、白细胞计数(WBC)、破膜时间、胎盘早剥、新生儿黄疸、新生儿低血糖、NRDS、新生儿HIE、新生儿RF以及新生儿体重之间差异无显著性(P>0.05)。与羊水偏少组及羊水量正常组比较,羊水过少组潜伏期显著缩短(P<0.05);羊水过少组剖宫产率为69.44%,羊水量正常组为38.46%,差异有显著性(P<0.01);羊水过少组临床IAI率为36.11%,羊水正常组为8.97%,差异有显著性(P<0.01);羊水过少组新生儿败血症发生率为27.78%,羊水正常组为8.97%,差异有显著性(P<0.01);羊水过少组新生儿新生儿吸入性肺炎发生率为88.89%,羊水正常组为62.82%,差异有显著性(P<0.01);羊水过少组胎儿窘迫发生率为19.44%,羊水正常组为2.56%,差异有显著性(P<0.01);羊水过少组新生儿窒息率为27.78%,羊水正常组为7.69%,差异有显著性(P<0.01);羊水过少组发生缺氧缺血性心肌损害为55.56%,羊水正常组为12.82%,差异有显著性(P<0.01)。Logistic回归分析结果显示羊水过少是羊膜腔感染及新生儿早发败血症的独立危险因素(P<0.05)。
结论:PPROM后的残余羊水量过少和潜伏期缩短,以及剖宫产率、临床IAI、胎儿窘迫、新生儿窒息、新生儿早发败血症、新生儿吸入性肺炎、新生儿缺氧缺血性心肌损害增加有关,可作为临床监测母儿安危及指导治疗的指标。
Objective: To determine the relationship between the residue amniotic fluid volume after PPROM and maternal-fetal prognosis.
Methods: 145 PPROM patients of pregnancy between 28-34 weeks were collected. Patients were devided into three groups according to the residue Amniotic fluid index(AFI): AFI<50mm; 50mm≤AFI < 80mm; 80mm≤AFI<180mm. The general information、the rates of intra-amniotic infection(IAI)、cesarean section and placental abruption; neonatal weight、rates of fetal distress、neonatal asphyxia、early-onset neonatal sepsis、neonatal aspiration pneumonia、neonatal respiratory distress syndrome (NRDS)、neonatal jaundice、neonatal hypoglycemia、neonatal hypoxic-ischemic encephalopathy (HIE)、neonatal respiratory failure (RF) and neonatal intraventricular hemorrhage (IVH) among the three groups were compared.
Results: The differences of patient’s age、gravidity and parity、white blood cell count(WBC)、time of rupture of membrane、neonatal birth weight、rates of placental abruption、neonatal jaundice、neonatal hypoglycemia、NRDS、neonatal HIE and neonatal RF among the three groups were not significant(P>0.05). Among the three groups, the group which AFI<50mm had a shorter incubation period(P<0.05),and higher rates of cesarean section(69.44%)、IAI(36.11%)、early-onset neonatal sepsis(27.78%)、neonatal aspiration pneumonia(88.89%)、fetal distress(16.67%)、neonatal asphyxia(27.78%) and hypoxic-ischemic myocardial injury(55.56%) (P<0.01). Logistic regression analysis showed that oligohydramnios might be an independent risk factor of intra-amniotic infection and early-onset neonatal sepsis.
Conclusion: The shorted the incubation period, the increased the rates of cesarean section, clinical IAI, fetal distress, neonatal asphyxia, early-onset neonatal sepsis, neonatal aspiration pneumonia and neonatal hypoxic-ischemic myocardial injury might be concerned with oligohydramnios after PPROM,which could be used to monitor the safety of mothers and infants,and indicate the treatments.
方法:收集145例孕周在28-34周的PPROM患者,并根据破膜后的残余羊水指数(AFI)值将患者分为3组:(1)羊水过少组(AFI<50mm);(2)羊水偏少组(50mm≤AFI<80mm);(3)羊水正常组(80mm≤AFI<180mm)。比较三组间患者一般资料、新生儿体重、临床羊膜腔感染、剖宫产、胎盘早剥、胎儿窘迫、新生儿窒息、新生儿早发败血症、新生儿吸入性肺炎、新生儿呼吸窘迫综合征(NRDS)、新生儿黄疸、新生儿低血糖、新生儿缺氧缺血性脑病(HIE)、新生儿呼吸衰竭(RF)以及新生儿脑室内出血(IVH)等母儿发病发生率的差异。
结果:三组间的患者年龄、孕产次、发热、白细胞计数(WBC)、破膜时间、胎盘早剥、新生儿黄疸、新生儿低血糖、NRDS、新生儿HIE、新生儿RF以及新生儿体重之间差异无显著性(P>0.05)。与羊水偏少组及羊水量正常组比较,羊水过少组潜伏期显著缩短(P<0.05);羊水过少组剖宫产率为69.44%,羊水量正常组为38.46%,差异有显著性(P<0.01);羊水过少组临床IAI率为36.11%,羊水正常组为8.97%,差异有显著性(P<0.01);羊水过少组新生儿败血症发生率为27.78%,羊水正常组为8.97%,差异有显著性(P<0.01);羊水过少组新生儿新生儿吸入性肺炎发生率为88.89%,羊水正常组为62.82%,差异有显著性(P<0.01);羊水过少组胎儿窘迫发生率为19.44%,羊水正常组为2.56%,差异有显著性(P<0.01);羊水过少组新生儿窒息率为27.78%,羊水正常组为7.69%,差异有显著性(P<0.01);羊水过少组发生缺氧缺血性心肌损害为55.56%,羊水正常组为12.82%,差异有显著性(P<0.01)。Logistic回归分析结果显示羊水过少是羊膜腔感染及新生儿早发败血症的独立危险因素(P<0.05)。
结论:PPROM后的残余羊水量过少和潜伏期缩短,以及剖宫产率、临床IAI、胎儿窘迫、新生儿窒息、新生儿早发败血症、新生儿吸入性肺炎、新生儿缺氧缺血性心肌损害增加有关,可作为临床监测母儿安危及指导治疗的指标。
Objective: To determine the relationship between the residue amniotic fluid volume after PPROM and maternal-fetal prognosis.
Methods: 145 PPROM patients of pregnancy between 28-34 weeks were collected. Patients were devided into three groups according to the residue Amniotic fluid index(AFI): AFI<50mm; 50mm≤AFI < 80mm; 80mm≤AFI<180mm. The general information、the rates of intra-amniotic infection(IAI)、cesarean section and placental abruption; neonatal weight、rates of fetal distress、neonatal asphyxia、early-onset neonatal sepsis、neonatal aspiration pneumonia、neonatal respiratory distress syndrome (NRDS)、neonatal jaundice、neonatal hypoglycemia、neonatal hypoxic-ischemic encephalopathy (HIE)、neonatal respiratory failure (RF) and neonatal intraventricular hemorrhage (IVH) among the three groups were compared.
Results: The differences of patient’s age、gravidity and parity、white blood cell count(WBC)、time of rupture of membrane、neonatal birth weight、rates of placental abruption、neonatal jaundice、neonatal hypoglycemia、NRDS、neonatal HIE and neonatal RF among the three groups were not significant(P>0.05). Among the three groups, the group which AFI<50mm had a shorter incubation period(P<0.05),and higher rates of cesarean section(69.44%)、IAI(36.11%)、early-onset neonatal sepsis(27.78%)、neonatal aspiration pneumonia(88.89%)、fetal distress(16.67%)、neonatal asphyxia(27.78%) and hypoxic-ischemic myocardial injury(55.56%) (P<0.01). Logistic regression analysis showed that oligohydramnios might be an independent risk factor of intra-amniotic infection and early-onset neonatal sepsis.
Conclusion: The shorted the incubation period, the increased the rates of cesarean section, clinical IAI, fetal distress, neonatal asphyxia, early-onset neonatal sepsis, neonatal aspiration pneumonia and neonatal hypoxic-ischemic myocardial injury might be concerned with oligohydramnios after PPROM,which could be used to monitor the safety of mothers and infants,and indicate the treatments.
引文
[1] Lee T, Silver H. Etiology and epidemiology of preterm premature rupture of the membranes. Clin Perinat, 2001,28(4):721-734.
[2] Johnson JW, Daikoku NH, Niebyl JR, et al.Premature rupture of the membranes and prolonged pregnancy. Obstet Gynecol,1981, 57(5):547-556.
[3] Gibbs RS, Blanco JD.Premature rupture of the membranes. Obstet Gynecol,1982, 60(6):671-679.
[4] Mead PB. Management of the patient with premature rupture of the membranes. Clin Perinatol, 1980, 7(2):243-255.
[5] Collaborative Group on Antenatal Steroid Therapy. Effect of antenatal dexamethasone on the prevention of respiratory distress syndrome. Am J Obstet Gynecol, 1981, 141(3):246-287.
[6] Ohlsson A. Treatments of preterm premature rupture of the membranes: a meta-analysis. Am J Obstet Gynecol, 1989, 160(4):890-906.
[7] Crowley PA, Chalmers I, Kiers MJ. The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. Br J Obstet Gynaecol, 1990, 97(1):11-25.
[8] Oyarzun E, Gomez R, Romero R, et al. Preterm premature rupture of the membranes: a meta-analysis of the effect of steroids on the prevention of respiratory distress syndrome. Rev Med Chil, 1991, 119(4):388-395.
[9] Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consents Statement, 1994, 12(2):1-24.
[10] Morales WJ, Diebel D, Lazar AJ, et al.The effect of antenatal dexamethasone administration on the prevention of respiratory distress syndrome in preterm gestations with premature rupture of the membranes. Am J Obstet Gynecol, 1986, 154(3):591-595.
[11] Mercer BM, Miodovnik M, Thurman GR, et al.Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes: a randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. JAMA, 1997, 278(12):989-995.
[12] Park JS, Yoon BH, Romero R, et al. The relationship between oligohydramnios and the onset of preterm labor in preterm premature rupture of membranes. Am J Obestet Gynecol, 2001, 184(3):459-462.
[13] Phelan JP, Smith CV, Broussard P, et al. Amniotic fluid volume assessment with four-quadrant technique at 36–42 week's gestation. J repord Med 1987, 32:540-2.
[14] Moore TR, Cayle JE. The amniotic fluid index in normal human pregnancy. Am J Obstet Gynecol,1990, 162(5):1168-1173.
[15] Vintzileos AM, Cmpbell WA, Nochimson DJ.degree oligohydramnios and pregnancy outcome in patients with prom. Obstet Gynecol, 1985, 66(2):162-167.
[16] MacMillan WE, Mann SE, Shmoys SM, et al. Amniotic fluid index as a predictor of latency after preterm premature rupture of the membranes. Am J Perinatol, 1994, 11(4):249-252.
[17] Piazze J, Anceschi MM, Cerekja A, et al. Validity of amniotic fluid index in preterm rupture of membranes. J Perinat Med, 2007,35(5):394-398.
[18] Mercer BM, Rabello YA, Thurnau GR, et al. The NICHD-MFMU antibiotic treatment of preterm PROM study: impact of initial amniotic fluid volume on pregnancy outcome. Am J Obstet Gynecol, 2006,194(2):438-445.
[19] Borna S, Borna H, Khazardoost S, 'Perinatal outcome in preterm premature rupture of membranes with Amniotic fluid index < 5 (AFI < 5). BMC Pregnancy Childbirth, 2004,4(1):15.
[20] Vermillion ST, Kooba AM, Soper DE. Amniotic fluid index values after preterm premature rupture of the membranes and subsequent perinatal infection. Am J Obstet Gynecol, 2000, 183(2):271-276.
[21] Yoon BH, Kim Ya, Romero R, et al.Association of oligohydramnios in women with preterm premature rupture of membranes with an inflammatory response in fetal amniotic and maternal compartments. Am J Obstet Gynecol,1999, 181(4):784-788.
[22] Gomez R, Romero R, Ghezzi F, et al. The fetal inflammatory response syndrome. Am J Obstet Gynecol, 1998, 179(1):194-202.
[23] Volante E, Gramellini D, Moretti S, et al.Alteration of the amniotic fluid and neonatal outcome. Acta Biomed, 2004, 1:71-75.
[24] Hnat MD, Mercer BM, Thurnau G. Perinatal outcomes in women with preterm rupture of membranes between 24 and 32 weeks of gestation and a history ofvaginal bleeding. Am J Obstet Gynecol, 2005 193(1):164-8.
[25] Lauria MR, Gonik B, Romero R.Pulmonary hypoplasia: pathogenesis, diagnosis and antenatal rediction. Obstet Gynecol, 1995,86(3):466-475.
[26] Deering SH, Patel N, Spong CY, , et al. Fetal growth after preterm premature rupture of membranes: is it related to amniotic fluid volume? J Matern Fetal Neonatal Med, 2007, 20(5):397-400.
[27] Wing DA, Fishman A, Gonzalez C. How frequently should the amniotic fluid index be performed during the course of antepartum testing? Am J Obstet Gynecol, 1996, 174:33-36.
[28]李央,李笑天,程海东等.胎膜早破后残余羊水量与宫内感染和新生儿发病率的相关性.实用妇产科杂志.2006,22(3):171-173.
[29]丰有吉,沈铿.妇产科学,1版.北京:人民卫生出版社,2005:39.
[1] Loeb LJ, Gaither K, Woo KS, et al. Outcomes in gestations between 20 and 25 weeks with preterm premature rupture of membranes. South Med J, 2006 , 99(7):709-712.
[2] Randelovi? G, Koci? B, Miljkovi?-Selimovi? B, et al. High-density cervical Ureaplasma urealyticum colonization in pregnant women as a risk factor for premature rupture of membranes.Vojnosanit Pregl, 2006 , 63(8):737-741.
[3] Yoneda-Izumi N, Toda A, Okabe M, et al. Alpha 1 antitrypsin activity is decreased in human amnion in premature rupture of the fetal membranes. Mol Hum Reprod, 2009,15:49-57.
[4] Ozer E. Telomerase activity of chorionic trophoblasts in preterm premature rupture of membranes. Pediatr Dev Pathol, 2008, 11(5):344-349.
[5] ACOG Committee on Practice Bulletins-Obstetrics.ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol, 2007,109:1007-1019.
[6] Juang CM, Chou P, Yen MS, et al. Adenomyosis and risk of preterm delivery. BJOG. 2007,114(2):165-169.
[7] Yackerson N, Piura B, Sheiner E. The influence of meteorological factors on the emergence of preterm delivery and preterm premature rupture of membrane. J Perinatol, 2008 , 28(10):707-711.
[8] Hermanns-LêT, Piérard GE .How I explore... the preterm premature rupture of fetal membranes by the ultrastructural examination of the skin. Rev Med Liege,2008,63(7-8):508-510.
[9] Spinnato JA 2nd, Freire S, Pinto e Silva JL, et al. Antioxidant supplementation and premature rupture of the membranes: a planned secondary analysis. Am J Obstet Gynecol, 2008, 199(4):433.e1-8.
[10] Shen TT, DeFranco EA, Stamilio DM, et al. A population-based study of race-specific risk for preterm premature rupture of membranes. Am J Obstet Gynecol, 2008 , 199(4):373.e1-7.
[11] Lee SE, Park JS, Norwitz ER, et al. Measurement of placental alpha-microglobulin-1 in cervicovaginal discharge to diagnose rupture ofmembranes.Obstet Gynecol. 2007,109:634-640.
[12] Kale E,Kuyumcuo?lu U, Kale A, et al. A New and Practical Aspartate Aminotransferase Test in Vaginal Washing Fluid for the Detection of Preterm Premature Rupture of Membranes. Fetal Diagn Ther.2008 , 24(4):425-428.
[13] Than NG, Kim SS, Abbas A, et al.Chorioamnionitis and increased galectin-1 expression in PPROM --an anti-inflammatory response in the fetal membranes? Am J Reprod Immunol, 2008 ,60(4):298-311.
[14] Kusanovic JP, Romero R, Mazaki-Tovi S, et al.Resistin in amniotic fluid and its association with intra-amniotic infection and inflammation. J Matern Fetal Neonatal Med. 2008 , 21(12):902-916.
[15] El-Haieg DO, Zidan AA, El-Nemr MM. The relationship between sonographic fetal thymus size and the components of the systemic fetal inflammatory response syndrome in women with preterm prelabour rupture of membranes. BJOG. 2008 ,115(7):836-841
[16] Kim KW, Romero R, Park HS, et al. A rapid matrix metalloproteinase-8 bedside test for the detection of intraamniotic inflammation in women with preterm premature rupture of membranes. Am J Obstet Gynecol. 2007 ,197(3):292.e1-5.
[17] Piazze J, Anceschi MM, Cerekja A, et al. Validity of amniotic fluid index in preterm rupture of membranes. J Perinat Med, 2007,35(5):394-398.
[18] Hutzal CE, Boyle EM, Kenyon SL, et al. Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metaanalysis. Am J Obstet Gynecol. 2008 ,199(6):620.e1-8.
[19] Gratacós E, Wu J, Yessldaglar N, et al. Successful sealing of fetoscopic access sites with collagen plugs in the rabbit model. Am J Obstet Gynecol,2000, 182: 142-146.
[20] O’Brien JM, Milligan DA, Barton JR. Gelatin sponge embolization. Fetal Diagn ther, 2002, 17: 8-10.
[21] Porreco RP, Heyborne KD, Shapiro H Amniocentesis in the management of preterm premature rupture of the membranes: a retrospective cohort analysis.J Matern Fetal Neonatal Med, 2008 ,21(8):573-579.
[22] Puertas A, Tirado P, Pérez I. Transcervical intrapartum amnioinfusion for preterm premature rupture of the membranes. Eur J Obstet Gynecol Reprod Biol. 2007 ,131(1):40-44.
[23] Liljedahl M, Martin H, Magnuson A, et al.Endothelial function in children with a history of premature prolonged rupture of membranes and bronchopulmonary dysplasia--a pilot study. Acta Paediatr, 2008 , 97(7):909-914.
[24] Velemínsky M Jr, PrádnáJ, Velemínsky M Sr, et al. Relationship of amniotic-type placenta inflammation to PPROM, PROM and risk of early onset neonatal sepsis. Neuro Endocrinol Lett, 2008 , 29(4):447-450.
[2] Johnson JW, Daikoku NH, Niebyl JR, et al.Premature rupture of the membranes and prolonged pregnancy. Obstet Gynecol,1981, 57(5):547-556.
[3] Gibbs RS, Blanco JD.Premature rupture of the membranes. Obstet Gynecol,1982, 60(6):671-679.
[4] Mead PB. Management of the patient with premature rupture of the membranes. Clin Perinatol, 1980, 7(2):243-255.
[5] Collaborative Group on Antenatal Steroid Therapy. Effect of antenatal dexamethasone on the prevention of respiratory distress syndrome. Am J Obstet Gynecol, 1981, 141(3):246-287.
[6] Ohlsson A. Treatments of preterm premature rupture of the membranes: a meta-analysis. Am J Obstet Gynecol, 1989, 160(4):890-906.
[7] Crowley PA, Chalmers I, Kiers MJ. The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. Br J Obstet Gynaecol, 1990, 97(1):11-25.
[8] Oyarzun E, Gomez R, Romero R, et al. Preterm premature rupture of the membranes: a meta-analysis of the effect of steroids on the prevention of respiratory distress syndrome. Rev Med Chil, 1991, 119(4):388-395.
[9] Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consents Statement, 1994, 12(2):1-24.
[10] Morales WJ, Diebel D, Lazar AJ, et al.The effect of antenatal dexamethasone administration on the prevention of respiratory distress syndrome in preterm gestations with premature rupture of the membranes. Am J Obstet Gynecol, 1986, 154(3):591-595.
[11] Mercer BM, Miodovnik M, Thurman GR, et al.Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes: a randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. JAMA, 1997, 278(12):989-995.
[12] Park JS, Yoon BH, Romero R, et al. The relationship between oligohydramnios and the onset of preterm labor in preterm premature rupture of membranes. Am J Obestet Gynecol, 2001, 184(3):459-462.
[13] Phelan JP, Smith CV, Broussard P, et al. Amniotic fluid volume assessment with four-quadrant technique at 36–42 week's gestation. J repord Med 1987, 32:540-2.
[14] Moore TR, Cayle JE. The amniotic fluid index in normal human pregnancy. Am J Obstet Gynecol,1990, 162(5):1168-1173.
[15] Vintzileos AM, Cmpbell WA, Nochimson DJ.degree oligohydramnios and pregnancy outcome in patients with prom. Obstet Gynecol, 1985, 66(2):162-167.
[16] MacMillan WE, Mann SE, Shmoys SM, et al. Amniotic fluid index as a predictor of latency after preterm premature rupture of the membranes. Am J Perinatol, 1994, 11(4):249-252.
[17] Piazze J, Anceschi MM, Cerekja A, et al. Validity of amniotic fluid index in preterm rupture of membranes. J Perinat Med, 2007,35(5):394-398.
[18] Mercer BM, Rabello YA, Thurnau GR, et al. The NICHD-MFMU antibiotic treatment of preterm PROM study: impact of initial amniotic fluid volume on pregnancy outcome. Am J Obstet Gynecol, 2006,194(2):438-445.
[19] Borna S, Borna H, Khazardoost S, 'Perinatal outcome in preterm premature rupture of membranes with Amniotic fluid index < 5 (AFI < 5). BMC Pregnancy Childbirth, 2004,4(1):15.
[20] Vermillion ST, Kooba AM, Soper DE. Amniotic fluid index values after preterm premature rupture of the membranes and subsequent perinatal infection. Am J Obstet Gynecol, 2000, 183(2):271-276.
[21] Yoon BH, Kim Ya, Romero R, et al.Association of oligohydramnios in women with preterm premature rupture of membranes with an inflammatory response in fetal amniotic and maternal compartments. Am J Obstet Gynecol,1999, 181(4):784-788.
[22] Gomez R, Romero R, Ghezzi F, et al. The fetal inflammatory response syndrome. Am J Obstet Gynecol, 1998, 179(1):194-202.
[23] Volante E, Gramellini D, Moretti S, et al.Alteration of the amniotic fluid and neonatal outcome. Acta Biomed, 2004, 1:71-75.
[24] Hnat MD, Mercer BM, Thurnau G. Perinatal outcomes in women with preterm rupture of membranes between 24 and 32 weeks of gestation and a history ofvaginal bleeding. Am J Obstet Gynecol, 2005 193(1):164-8.
[25] Lauria MR, Gonik B, Romero R.Pulmonary hypoplasia: pathogenesis, diagnosis and antenatal rediction. Obstet Gynecol, 1995,86(3):466-475.
[26] Deering SH, Patel N, Spong CY, , et al. Fetal growth after preterm premature rupture of membranes: is it related to amniotic fluid volume? J Matern Fetal Neonatal Med, 2007, 20(5):397-400.
[27] Wing DA, Fishman A, Gonzalez C. How frequently should the amniotic fluid index be performed during the course of antepartum testing? Am J Obstet Gynecol, 1996, 174:33-36.
[28]李央,李笑天,程海东等.胎膜早破后残余羊水量与宫内感染和新生儿发病率的相关性.实用妇产科杂志.2006,22(3):171-173.
[29]丰有吉,沈铿.妇产科学,1版.北京:人民卫生出版社,2005:39.
[1] Loeb LJ, Gaither K, Woo KS, et al. Outcomes in gestations between 20 and 25 weeks with preterm premature rupture of membranes. South Med J, 2006 , 99(7):709-712.
[2] Randelovi? G, Koci? B, Miljkovi?-Selimovi? B, et al. High-density cervical Ureaplasma urealyticum colonization in pregnant women as a risk factor for premature rupture of membranes.Vojnosanit Pregl, 2006 , 63(8):737-741.
[3] Yoneda-Izumi N, Toda A, Okabe M, et al. Alpha 1 antitrypsin activity is decreased in human amnion in premature rupture of the fetal membranes. Mol Hum Reprod, 2009,15:49-57.
[4] Ozer E. Telomerase activity of chorionic trophoblasts in preterm premature rupture of membranes. Pediatr Dev Pathol, 2008, 11(5):344-349.
[5] ACOG Committee on Practice Bulletins-Obstetrics.ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol, 2007,109:1007-1019.
[6] Juang CM, Chou P, Yen MS, et al. Adenomyosis and risk of preterm delivery. BJOG. 2007,114(2):165-169.
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