胎膜早破型早产不良围生结局风险要素研究的新进展

New Advances in Research on Risk Factors for Adverse Perinatal Outcomes in Preterm Births with Premature Rupture of Membranes

摘要: 胎膜早破(premature rupture of membranes, PROM)系指孕妇在尚未出现规律性宫缩的情况下，于临产前即发生胎膜的自发性破裂，且该破裂事件通常发生于预期分娩启动前至少一至两小时。此临床征象作为产科常见并发症之一，通俗来说就是包裹胎儿、胎儿附属物及羊水的羊膜和绒毛膜在进入分娩产程之前就发生了自然性破裂，羊水自发顺势经阴道流出。依据妊娠周期进行临床分类，若胎膜破裂发生于妊娠未满37周之前，定义为未足月胎膜早破(preterm premature rupture of membranes, PPROM)，否则为足月胎膜早破。最新流行病学大数据统计，单胎妊娠PPROM的发病率高达2%~4%，双胎妊娠PPROM则高达7%~20%，所有早产的病因中胎膜早破约占1/3，且近年来该数值呈现明显的持续上升的趋势。PPROM是产科常见并发症之一，若不及时处理，可引起绒毛膜羊膜炎、脐带脱垂、胎儿窘迫等不良围产结局甚至危及母婴生命。目前PPROM的病因尚不完全明确，本文主要对PPROM的相关风险因素从胎盘深部浸润缺陷、感染、宫颈机能、微量元素、宫腔压力，国家与民族地区、生活习惯以及妊娠相关合并症等方面的研究新态势进行综述。

Abstract: Premature rupture of membranes (PROM) refers to the spontaneous rupture of the amniotic and chorionic membranes before the onset of regular uterine contractions in pregnant women, usually occurring at least one to two hours before the expected onset of labor. This clinical sign, as one of the common complications in obstetrics, simply means that the membranes enclosing the fetus, fetal appendages, and amniotic fluid rupture naturally before the onset of labor, and the amniotic fluid flows out of the vagina spontaneously. According to the gestational period, if the rupture of membranes occurs before 37 weeks of gestation, it is defined as preterm premature rupture of membranes (PPROM), otherwise it is term premature rupture of membranes. According to the latest epidemiological big data statistics, the incidence of PPROM in singleton pregnancies is as high as 2% to 4%, and in twin pregnancies it is as high as 7% to 20%. Among all the causes of preterm birth, premature rupture of membranes accounts for about one-third, and this figure has shown a significant and continuous upward trend in recent years. PPROM is a common complication in obstetrics. If not treated promptly, it can lead to adverse perinatal outcomes such as chorioamnionitis, umbilical cord prolapse, and fetal distress, and even endanger the lives of both the mother and the baby. Currently, the etiology of PPROM is not completely clear. This article mainly reviews the new research trends on the related risk factors of PPROM from aspects such as deep placental invasion defects, infection, cervical function, trace elements, intrauterine pressure, regions and ethnic groups, living habits, and pregnancy-related complications.