背景:急性胃肠炎(AF),脐带内炎症的组织学诊断,代表胎儿炎症反应,并与新生儿不良结局相关.在并发羊膜腔内感染(IAI)的足月分娩中,与发生AF相关的孕产妇和产时危险因素鲜为人知。
目的:确定合并IAI的足月分娩中与发生房颤相关的孕产妇和产时危险因素。
方法:IRB批准后,我们在2013年至2017年期间对一个三级中心的受临床IAI影响的足月分娩进行了回顾性队列研究,胎盘病理符合组织学绒毛膜羊膜炎.排除标准包括宫内胎儿死亡,缺少分娩信息或胎盘病理,并记录了先天性胎儿畸形。产妇社会人口统计学,产前,使用双变量统计,比较了房颤患者与无房颤患者的病理和产时因素。开发回归模型来估计调整后的优势比(AOR)。
结果:在123名符合纳入标准的患者中,75(61%)在胎盘病理上有AF。与无AF的胎盘标本相比,在母体体重指数(BMI)≥30kg/m2的患者中,房颤的发生率更高(58.7%vs.39.6%,p=0.04)和胎膜破裂(ROM)持续时间增加的分娩过程(17.3vs,9.6小时,p=0.001)。胎儿头皮电极(FSE)的使用频率较低(5.3%vs.16.7%,p=0.04)与无AF的病例相比。在回归模型中,孕妇BMI≥30kg/m2(aOR2.67,95%CI1.21,5.90)和ROM>18小时(aOR2.48,95%CI1.07,5.75)与AF显著相关.FSE使用(aOR0.18,95%CI0.04,0.71)与房颤呈负相关。
结论:在IAI和组织学绒毛膜羊膜炎的足月分娩中,孕妇BMI≥30kg/m2和ROM>18小时与胎盘病理上的AF相关。随着对房颤临床影响的深入了解,预测哪种妊娠发生风险最大的能力,可以为预测新生儿败血症和相关合并症的风险提供量身定制的方法.
Acute funisitis-the histologic diagnosis of inflammation within the umbilical cord-represents a fetal inflammatory response and has been associated with adverse neonatal outcomes. Little is known regarding the maternal and intrapartum risk factors associated with the development of acute funisitis among term deliveries complicated by intraamniotic infection.
This study aimed to identify the maternal and intrapartum risk factors associated with developing acute funisitis among term deliveries complicated by intraamniotic infection.
After institutional review board approval, we conducted a retrospective cohort study of term deliveries affected by clinical intraamniotic infection at a single tertiary center between 2013 and 2017, with placental pathology consistent with histologic chorioamnionitis. The exclusion criteria included intrauterine fetal demise, missing delivery information or placental pathology, and documented congenital fetal abnormalities. Maternal sociodemographic, antepartum, and intrapartum factors were compared among patients with acute funisitis on pathology to those without acute funisitis using bivariate statistics. Regression models were developed to estimate the adjusted odds ratios.
Of 123 patients meeting the inclusion criteria, 75 (61%) had acute funisitis on placental pathology. Compared with placental specimens without acute funisitis, acute funisitis was observed more frequently among patients with maternal BMI ≥30 kg/m2 (58.7% vs 39.6%, P=.04) and labor courses with increased rupture of membrane duration (17.3 vs 9.6 hours, P=.001). Use of fetal scalp electrode was observed less frequently in acute funisitis (5.3% vs 16.7%, P=.04) than cases without acute funisitis. In regression models, maternal BMI ≥30 kg/m2 (adjusted odds ratio, 2.67; 95% confidence interval, 1.21-5.90) and rupture of membrane >18 hours (adjusted odds ratio, 2.48; 95% confidence interval, 1.07-5.75) were significantly associated with acute funisitis. Fetal scalp electrode use (adjusted odds ratio, 0.18; 95% confidence interval, 0.04-0.71) was negatively associated with acute funisitis.
In term deliveries with intraamniotic infection and histologic chorioamnionitis, maternal BMI ≥30 kg/m2, and rupture of membrane>18 hours were associated with acute funisitis on placental pathology. As insight into the clinical impact of acute funisitis grows, the ability to predict which pregnancies are at the greatest risk for its development may allow for a tailored approach to predicting neonatal risk for sepsis and related comorbidity.