产时发热程度对母婴结局的影响研究

doi:10.12114/j.issn.1007-9572.2023.0318

摘要/Abstract

摘要： 背景产时发热是产科常见临床表现，可使剖宫产率、阴道助产率、新生儿窒息率增加。影响产时发热的因素包括孕产期合并症及并发症、引产时间、分娩镇痛、试产时间、产房温度、内诊次数，这些因素可独立存在，也可互为因果。在产时发热的孕产妇，是否最高体温越高，母婴预后越差？对此进行研究有利于指导产时发热孕产妇的临床预后及管理策略。目的探讨足月单胎初产妇试产过程中产时发热及其程度对母婴结局的影响。方法纳入2019年于首都科大学附属北京妇产医院分娩，且在产程中诊断为产时发热的足月单胎初产妇994例作为发热组，同期按照1∶1比例入组符合标准的未发热单胎初产妇作为对照组，比较发热组与对照组孕产妇的一般资料、并发症发生情况、催引产情况、分娩方式及母婴结局，进一步根据产时发热体温程度将发热组分成4个亚组：第1亚组体温37.3~<37.5 ℃，共142例；第2亚组体温37.5~<38.0 ℃，共600例；第3亚组38.0~<38.5 ℃，共213例；第4亚组体温≥38.5 ℃，共39例。对各亚组孕产妇的一般资料、催引产情况、产科并发症、分娩方式以及母婴结局进行对比分析。结果发热组入组994例，对照组入组987例。发热组孕产妇催引产率、催引产时间≥3 d的比例高于对照组（P<0.05）。发热组孕产妇胎膜早破、妊娠期高血压疾病、妊娠期糖尿病发生率均高于对照组（P<0.05）。发热组剖宫产、产褥感染、新生儿窒息、羊水污染发生率及新生儿转新生儿重症监护病房（NICU）发生率高于对照组（P<0.05）；两组新生儿体质量比较，差异无统计学意义（P>0.05）。各亚组催引产率、催引产≥3 d的比例及孕产妇胎膜早破、妊娠期高血压疾病、妊娠期糖尿病发生率比较，差异均无统计学意义（P>0.05）。各亚组剖宫产、产褥感染、新生儿窒息、羊水污染、转NICU发生率及新生儿体质量比较，差异均无统计学意义（P>0.05）。结论产时发热孕产妇并发症及催引产率、剖宫产率、产褥感染及新生儿窒息发生率升高，体温升高程度与分娩方式及母婴结局之间未体现相关性。

关键词: 产时, 发热, 发热程度, 剖宫产术, 新生儿窒息, 病例对照研究

Abstract:

Background

Intrapartum fever is a common clinical manifestation in obstetrics, which increases the rates of cesarean section, vaginal instrumental delivery and neonatal asphyxia. The influencing factors of intrapartum fever include pregnancy comorbidities and complications, labor induction duration, labor analgesia, trial delivery time, temperature of delivery room, and number of pelvic examination. These factors can exist independently or be causal. Is it true that the higher maximum body temperature correlates with worse maternal and neonatal outcomes in women with intrapartum fever? The study on it is useful to guide the clinical prognosis and management strategies of pregnant women with intrapartum fever.

Objective

To investigate the effect of intrapartum fever and its severity on maternal and fetal outcomes during trial delivery of full-term singleton primipara.

Methods

A total of 994 full-term singleton primiparas who delivered in 2019 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University and diagnosed with intrapartum fever during labor were included as fever group, the full-term singleton primiparas without intrapartum fever who met the criteria were enrolled in a 1∶1 ratio as the control group during the same period. The general situation, complications, labor induction, delivery mode, and maternal and infant outcomes were compared between the fever group and control group. The fever group was further divided into 4 subgroups according to the degree of body temperature at delivery, including 142 cases in subgroup 1 with temperature of 37.3 to <37.5℃, 600 cases in subgroup 2 with temperature of 37.5 to <38 ℃, 213 cases in subgroup 3 with temperature of 38.0 to <38.5 ℃, 39 cases in subgroup 4 with temperature ≥38.5 ℃. General information, obstetric complications, labor induction, delivery mode, and maternal and fetal outcomes of the four subgroups were compared and analyzed.

Results

A total of 994 cases were included in the fever group and 987 cases in the control group. The proportions of labor induction and induced labor≥3 days in the fever group were higher than those in the control group (P<0.05) . The incidence of premature membrane rupture, gestational hypertension and gestational diabetes in the fever group was higher than the control group (P<0.05) . The rates of cesarean section, puerperal infection, neonatal asphyxia, amniotic fluid contamination neonatal NICU transfer in the fever group were higher than those in the control group (P<0.05) . There was no statistically significant difference between the two groups in terms of neonatal body mass (P>0.05) . There was no statistically significant difference in the rates of labor induction, proportion of induced labor≥3 days and incidence of premature rupture of fetal membranes, gestational hypertension and gestational diabetes among the subgroups (P>0.05) . The differences were not statistically significant when comparing the rates of cesarean delivery, puerperal infection, neonatal asphyxia, amniotic fluid contamination and neonatal NICU transfer among the subgroups (P>0.05) .

Conclusion

The incidence of maternal complications, labor induction, cesarean section, puerperal infection and neonatal asphyxia increased in patients with fever during labor, the severity of fever was not related to the mode of delivery and maternal and infant outcomes.

Key words: Intrapartum, Fever, Degree of fever, Cesarean section, Asphyxia neonatorum, Case-control studies

刘丽恒,邹丽颖,米雪,等. 产时发热程度对母婴结局的影响研究[J]. 中国全科医学, 2024, 27(06): 699-703. DOI: 10.12114/j.issn.1007-9572.2023.0318.
LIU Liheng,ZOU Liying,MI Xue, et al. Effect of Intrapartum Fever Severity on Maternal and Fetal Outcomes[J]. Chinese General Practice, 2024, 27(06): 699-703. DOI: 10.12114/j.issn.1007-9572.2023.0318.

图/表 6

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组别	例数	年龄（岁）	分娩孕周（周）
对照组	987	31.05±3.08	39.03±0.91
发热组	994	31.06±3.13	39.06±0.92
t值		1.503	1.022
P值		0.979	0.465

组别	例数	年龄（岁）	分娩孕周（周）
对照组	987	31.05±3.08	39.03±0.91
发热组	994	31.06±3.13	39.06±0.92
t值		1.503	1.022
P值		0.979	0.465

组别	例数	催引产	催引产时间≥3 d	PROM	HDCP	GDM
对照组	987	368（37.28）	67（6.79）	173（17.53）	11（1.11）	97（9.83）
发热组	994	420（42.25）	106（10.66）	328（33.00）	23（2.31）	130（13.08）
χ²值		5.104	9.334	62.730	4.223	5.158
P值		0.024	0.002	<0.001	0.040	0.023

组别	例数	催引产	催引产时间≥3 d	PROM	HDCP	GDM
对照组	987	368（37.28）	67（6.79）	173（17.53）	11（1.11）	97（9.83）
发热组	994	420（42.25）	106（10.66）	328（33.00）	23（2.31）	130（13.08）
χ²值		5.104	9.334	62.730	4.223	5.158
P值		0.024	0.002	<0.001	0.040	0.023

组别	例数	剖宫产[例（%）]	产褥感染[例（%）]	新生儿体质量（g）	新生儿窒息[例（%）]	羊水污染[例（%）]	新生儿转NICU[例（%）]
对照组	987	114（11.55）	5（0.51）	3 483.52±389.18	6（0.61）	13（1.32）	121（12.26）
发热组	994	340（34.21）	14（1.41）	3 485.34±347.71	16（1.61）	28（2.82）	160（16.10）
χ²（t）值		143.888	4.241	1.676^a	4.525	5.496	5.991
P值		<0.001	0.039	0.634	0.033	0.019	0.014