Risk factors for premature rupture of membranes complicated with histological stage Ⅰacute intraamniotic infection

doi:10.3877/cma.j.issn.1674-1358.2022.03.005

Abstract

Abstract:

Objective

To investigate the clinical characteristics and risk factors of pregnant women and their newborns with premature rupture of membranes (PROM) complicated with histological stageⅠacute intraamniotic infection (AIAI), and to provide refined data for optimizing the perinatal diagnosis and treatment program.

Methods

The clinical data and placental pathology results of 247 PROM mothers and their infants from Beijing Huairou Maternal and Child Health Hospital Affiliated to Capital Medical University from June 1st, 2016 to January 31st, 2021 were analyzed, retrospectively. The differences of perinatal infection related factors (maternal fever, uterine tenderness, amniotic fluid pollution, PROM duration, fetal distress, maternal leukocyte, C-reactive protein, antenatal anti-infection treatment, etc) between 88 cases with PROM and acute intraamniotic infection (AIAI/PROM group) and 159 cases with PROM (PROM group) were compared by Chi-square tests, respectively. The risk factors of histological stage Ⅰ AIAI were confirmed by Logistic regression analysis. The receiver operating characteristic (ROC) were curved and the diagnostic efficacy of high-risk factors were evaluated by Medcalc software.

Results

Among the 88 mothers in AIAI/PROM group, 19.32% (17/88) cases had prenatal fever, 2.27% (2/88) cases had uterine tenderness and 6.82% (6/88) cases had amniotic fluid pollution; 7.95% (7/88) cases with fetal distress. There were significant differences of perinatal clinical indicators such as maternal fever (χ² = 8.666, P = 0.003), PROM duration (χ² = 3.128, P = 0.001), PROM duration > 18 h (χ² = 9.095, P = 0.003) and maternal WBC count (χ² = 2.544, P = 0.011), leukocyte count > 15 × 10⁹/L (χ² = 8.000, P = 0.005) between the two groups. Multivariate regression analysis showed PROM duration > 18 h was the main related factor (OR = 2.82, 95%CI: 1.485-5.364, P = 0.002) of histological stagⅠ AIAI, which increased the risk of histological stageⅠ AIAI by 2.82 times in mothers with PROM. The area under ROC (AUC) of maternal PROM duration, maternal WBC count and the combined two indicators to the risk of histological stageⅠAIAI were 0.623, 0.626 and 0.627, respectively; but there was no significant difference between any two groups compared by Medcalc software (all P > 0.05).

Conclusions

The clinical symptoms and signs of PROM mothers complicated with histological stage ⅠAIAI were not typical. PROM duration > 18 h was the main risk factor for the occurrence of histological stage ⅠAIAI. Both PROM duration, maternal WBC count and the combined two indicators were valuable for the risk judgment of histological stage Ⅰ AIAI, but the accuracy was not high.

Key words: Premature rupture of membranes, Acute intraamniotic infection, Perinatal

Leilei Guo, Xiaoxia Guo, Huihui Zeng. Risk factors for premature rupture of membranes complicated with histological stage Ⅰacute intraamniotic infection[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(03): 172-177.

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References 25

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组别	例数	孕次G1 [例（%）]	产次P1 [例（%）]	平均胎龄（±s，周）	母孕期并发症[例（%）]
AIAI/PROM组	88	37（42.05）	65（73.86）	37.58 ± 3.34	59（67.05）
PROM组	159	54（33.96）	87（54.72）	37.57 ± 2.17	109（68.55）
统计量		χ² = 1.591	χ² = 8.774	t = 0.002	χ² = 0.059
P值		0.207	0.003	0.998	0.808

组别	例数	孕次G1 [例（%）]	产次P1 [例（%）]	平均胎龄（±s，周）	母孕期并发症[例（%）]
AIAI/PROM组	88	37（42.05）	65（73.86）	37.58 ± 3.34	59（67.05）
PROM组	159	54（33.96）	87（54.72）	37.57 ± 2.17	109（68.55）
统计量		χ² = 1.591	χ² = 8.774	t = 0.002	χ² = 0.059
P值		0.207	0.003	0.998	0.808

指标	AIAI/PROM组（88例）	PROM组（159例）	统计量	P值
孕母产时发热[例（%）]	17（19.32）	11（6.92）	χ² = 8.666	0.003^a
子宫触痛[例（%）]	2（2.27）	0（0.00）	—	0.126^b
羊水污染[例（%）]	6（6.82）	9（5.66）	χ² = 0.133	0.715^a
PROM时长[M（P25，P75），h]	18（11.50，36.00）	12（7.00，27.00）	Z = 3.130	0.002^c
PROM> 18 h [例（%）]	49（55.68）	57（35.85）	χ² = 9.095	0.003^a
胎儿窘迫[例（%）]	7（7.95）	8（5.03）	χ² = 0.849	0.357^a
WBC计数[M（P25，P75），× 10⁹/L]	10.07（7.77，14.23）	8.90（7.67，11.53）	Z = 2.544	0.011^c
WBC > 15 × 10⁹/L [例（%）]	19（21.59）	14（8.81）	χ² = 8.000	0.005^a
孕母C-反应蛋白[M（P25，P75），mg/L ]	14.75（5.32，42.47）	8.65（3.21，31.49）	Z = 0.721	0.471^c
孕母产前抗感染治疗[例（%）]	68（77.27）	105（66.04）	χ² = 1.299	0.254^a

指标	AIAI/PROM组（88例）	PROM组（159例）	统计量	P值
孕母产时发热[例（%）]	17（19.32）	11（6.92）	χ² = 8.666	0.003^a
子宫触痛[例（%）]	2（2.27）	0（0.00）	—	0.126^b
羊水污染[例（%）]	6（6.82）	9（5.66）	χ² = 0.133	0.715^a
PROM时长[M（P25，P75），h]	18（11.50，36.00）	12（7.00，27.00）	Z = 3.130	0.002^c
PROM> 18 h [例（%）]	49（55.68）	57（35.85）	χ² = 9.095	0.003^a
胎儿窘迫[例（%）]	7（7.95）	8（5.03）	χ² = 0.849	0.357^a
WBC计数[M（P25，P75），× 10⁹/L]	10.07（7.77，14.23）	8.90（7.67，11.53）	Z = 2.544	0.011^c
WBC > 15 × 10⁹/L [例（%）]	19（21.59）	14（8.81）	χ² = 8.000	0.005^a
孕母C-反应蛋白[M（P25，P75），mg/L ]	14.75（5.32，42.47）	8.65（3.21，31.49）	Z = 0.721	0.471^c
孕母产前抗感染治疗[例（%）]	68（77.27）	105（66.04）	χ² = 1.299	0.254^a

影响因素	β值	标准误	Wald χ²值	OR值	P值
孕母产时发热	1.170	0.413	8.023	3.222	0.005
PROM时长	-0.002	0.003	0.539	0.998	0.463
PROM> 18 h	0.810	0.271	8.943	2.248	0.003
WBC计数	0.109	0.035	9.790	1.116	0.002
WBC > 15 × 10⁹/L	1.048	0.381	7.551	2.852	0.006

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