目的 探讨组织学绒毛膜羊膜炎(histological ChorioamnionitiS,HCA)与早产妊娠结局的关系.方法 选择2015年1月～2017年12月在本院产科住院分娩的早产病例共218例,根据产妇的胎盘病理诊断结果将其分为两组:观察组胎盘病理诊断组织学绒毛膜羊膜炎,对照组无诊断组织学绒毛膜羊膜炎.对两组产妇的分娩孕周、胎膜早破率、产褥感染率、产后出血率、伤口愈合不良率以及两组新生儿的平均体质量、早发型败血症率、窒息率、呼吸窘迫综合征率、病理性黄疸率、新生儿死亡率进行比较,探讨组织学绒毛膜羊膜炎对于早产妊娠结局的影响.结果 观察组产妇的分娩孕周为(32.0±1.0)周,产后出血率、胎膜早破率、产褥感染率、伤口愈合不良率分别是21.24％、80.50％、16.81％、11.50％;对照组产妇的分娩孕周为(34.0±1.0)周,产后出血率、胎膜早破率、产褥感染率、伤口愈合不良率分别是10.48％、65.70％、7.62％、3.81％;观察组产妇的分娩孕周小,胎膜早破率、伤口愈合不良率、产褥感染率、产后出血率均明显高于对照组产妇,差异有统计学意义(P＜0.05).观察组新生儿平均体质量(1710±355)g,窒息率、早发型败血症率、呼吸窘迫综合征率、病理性黄疸率、新生儿死亡率分别为21.24％、33.63％、38.05％、19.47％、9.73％;对照组新生儿平均体质量(2270±450)g,窒息率、早发型败血症率、呼吸窘迫综合征率、病理性黄疸率、新生儿死亡率分别是9.52％、18.10％、12.38％、8.57％、2.86％;观察组新生儿平均体质量低,早发型败血症率、窒息率、呼吸窘迫综合征率、病理性黄疸率、新生儿死亡率均明显升高,差异具有统计学意义(P＜0.05).结论 产科医师应该对所有的早产患者做胎盘病理检查,避免漏诊HCA,以帮助宫内感染的产妇及高危新生儿早诊治,改善预后.%Objective To investigate the relationship between histological chorioamnionitis(HCA) and the outcome of preterm labor. Methods A total of 218 cases of premature delivery in the Department of Obstetrics and Gynecology of our hospital from January, 2015 to December, 2017 were divided into two groups according to the result of placenta pathological diagnosis. The observation group was diagnosed with histological chorioamnionitis by placenta pathology examination. The control group was not diagnosed with histological chorioamnionitis. The delivery gestational week, the rate of premature rupture of membranes, the rate of puerperal infection, the rate of postpartum hemorrhage, the rate of wound healing failure, the average body mass of newborn infants, the rate of early-onset sepsis, asphyxia, respiratory distress syndrome rate, pathological jaundice rate, neonatal mortality between the two groups were compared. And the impact of histological chorioamnionitis on the outcome of preterm labor was explored. Results The delivery gestational week of the observation group was (32. 0±1. 0) weeks, and the rate of postpartum hemorrhage, the rate of premature rupture of membranes, the rate of puerperal infection and the rate of wound healing were 21. 24％, 80. 50％, 16. 81％, 11. 50％, respectively. The delivery gestational week of the control group was(34. 0±1. 0) weeks, and the rate of postpartum hemorrhage, the rate of premature rupture of membranes, the rate of puerperal infection and the rate of wound healing were 10. 48％, 65. 70％, 7. 62％, 3. 81％, respectively. The delivery gestational week of the observation group was small. And the rate of premature rupture of membranes, wound healing failure rate, puerperal infection rate, postpartum hemorrhage rate in the observation group was significantly higher than that of the control group, and the difference was statistically significant(P＜0. 05). The mean neonatal weight in the observation group was(1710±355)g,and the asphyxia rate, early-onset sepsis rate, respiratory distress syndrome rate, pathological jaundice rate and neonatal mortality were 21. 24％, 33. 63％, 38. 05％, 19. 47％ and 9. 73％. The mean neonatal weight in the control group was(2270±450)g,and the asphyxia rate, early-onset sepsis rate, respiratory distress syndrome rate, pathological jaundice rate, neonatal mortality were 9. 52％, 18. 10％, 12. 38％, 8. 57％, 2. 86％. The average body weight of infants in the observation group was low. And the rates of early onset sepsis, asphyxia, respiratory distress syndrome, pathological jaundice and neonatal mortality were significantly increased. The difference was significant (P＜0. 05). Conclusion The placental pathology examination in all preterm patients should be done to avoid missed diagnosis of HCA, and to help early diagnosis and treatment of pregnant women with intrauterine infection and high-risk newborns and improve prognosis.
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