The Maternal-Fetal Medicine Units cesarean registry: Chorioamnionitis at term and its duration-relationship to outcomes
The Maternal-Fetal Medicine Units cesarean registry: Chorioamnionitis at term and its duration-relationship to outcomes
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DOI：
10.1016/j.ajog.2004.03.003
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发表时间：
2004-07-01
影响因子：
9.8
通讯作者：
Spong, CY
中科院分区：
文献类型：
--
作者：
Rouse, DJ;Landon, M;Spong, CY
目的：本研究的目的是评估绒毛膜炎和其持续时间不良孕产妇，胎儿和新生儿outcomes.Study设计：这是一个13所大学的中心，前瞻性观察研究之间的关系。所有从1999年1月1日至2000年12月31日接受初次剖宫产的足月单胎妊娠妇女均符合条件。数据提取是系统的，并由训练有素的研究护士进行。使用相对危险度（RR）和95%CI比较了有和无临床诊断的绒毛膜炎的妊娠的选定不良结局。将绒毛膜炎的持续时间分为5个时间段（小于或等于3 h、>3-6 h、>6-9 h、>9-12 h和>12 h），并通过Mantel-Haenszel趋势检验比较各自的结局。此外，回归分析用于计算比值比（OR）和95% CI，绒毛膜炎持续时间长度作为连续解释变量。分析了16,650例妊娠，1965例（12%）患有绒毛膜炎，与母体输血、子宫收缩乏力、脓毒性盆腔血栓性静脉炎和盆腔脓肿的风险显著增加相关（RR 2.3-3.7），以及5分钟阿普加评分≤ 3、新生儿败血症和癫痫发作（RR 2.1-2.8）。通过趋势检验，只有宫缩乏力（P <0.01）、母亲输血（P = 0.03）、母亲入住重症监护室（P = 0.02）和5分钟Apgar评分小于或等于3分（P <0.01）与绒毛膜炎持续时间相关。Logistic回归分析显示，只有子宫收缩乏力（绒毛膜炎每小时OR 1.03，95% CI 1.00-1.06），5分钟Apgar评分：3（OR 1.09，95% CI 1.00-1.16），出生后24小时内进行新生儿机械通气结论：绒毛膜炎与剖宫产术后并发症的发生率有关，剖宫产术后并发绒毛膜炎的发生率与剖宫产术后并发症的发生率有关，剖宫产术后并发绒毛膜炎的发生率与剖宫产术后并发症的发生率有关。然而，绒毛膜炎的持续时间与大多数母亲或胎儿-新生儿不良结局指标无关。(C)2004爱思唯尔公司All rights reserved.
Objective: The purpose of this study was to evaluate the relationship between chorioamnionitis and its duration to adverse maternal, fetal, and neonatal outcomes.Study design: This was a 13-university center, prospective observational study. All women at term carrying a singleton gestation who underwent primary cesarean from January 1, 1999 to December 3 1, 2000 were eligible. Data abstraction was systematic and performed by trained research nurses. Selected adverse outcomes were compared between pregnancies with, and without, clinically diagnosed chorioamnionitis using relative risks (RRs) and 95% CIs. The duration of chorioamnionitis was stratified into 5 intervals (less than or equal to3 h, >3-6 h, >6-9 h, >9-12 h, and >12 h), and respective outcomes compared by Mantel-Haenszel test for trend. Additionally, regression analysis was used to compute odds ratios (ORs) and 95% CIs for chorioamnionitis duration length as a continuous explanatory variable.Results: 16,650 pregnancies were analyzed, 1965 (12%) with chorioamnionitis, which was associated with significantly increased risks of maternal blood transfusion, uterine atony, septic pelvic thrombophlebitis, and pelvic abscess (RR 2.3-3.7), as well as 5-minute Apgar less than or equal to3, neonatal sepsis, and seizures (RR 2.1-2.8). By test of trend, only uterine atony (P < .01), maternal blood transfusion (P = .03), maternal admission to intensive care unit (P = .02), and 5-minute Apgar less than or equal to3 (P < .01) were associated with duration of chorioamnionitis. By logistic analysis, only uterine atony (OR for each hour of chorioamnionitis 1.03, 95% Cl 1.00-1.06), 5-minute Apgar : 3 (OR 1.09, 95% Cl 1.00-1.16), and neonatal mechanical ventilation within 24 hours of birth (OR 1.07, 95% CI 1.01-1.12) were significantly associated with chorioamnionitis duration.Conclusion: Chorioamnionitis was associated with increased rates of morbidity after cesarean at term. The duration of chorioamnionitis, however, was not related to most measures of adverse maternal or fetal-neonatal outcome. (C) 2004 Elsevier Inc. All rights reserved.