مقایسه اثر پارگی کیسه آب در دو مرحله غیرفعال و فعال زایمان بر پیامدهای مادری و نوزادی: مطالعه هم‌گروهی آینده‌نگر مبتنی بر جمعیت

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه مامایی، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، پژوهشکده پیشگیری از بیماری‌های غیرواگیر، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

2 مربی گروه مامایی، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، پژوهشکده پیشگیری از بیماری‌های غیرواگیر، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

3 استادیار گروه اپیدمیولوژی و آمار زیستی، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، پژوهشکده پیشگیری از بیماری‌های غیرواگیر، دانشکده بهداشت، دانشگاه، علوم پزشکی قزوین، قزوین، ایران.

10.22038/ijogi.2025.81382.6145

چکیده

مقدمه: پارگی پرده ­های جنینی ممکن است قبل و یا بعد از شروع درد­های زایمانی در هر سنی از بارداری اتفاق بیافتد و سبب پیامدهای مادری و نوزادی شود. مطالعه حاضر با هدف بررسی تأثیر زمان پاره شدن پرده ­های جنینی بر پیامدهای کوتاه‌مدت و درازمدت مادری و نوزادی انجام شد.
روش‌کار: این مطالعه کوهورت در بازه زمانی 99-1396 بر روی 775 زن باردار با سن حاملگی 37 هفته و بالاتر که جهت زایمان به بیمارستان کوثر شهرستان قزوین مراجعه کرده بودند و شرایط ورود به مطالعه را داشتند، انجام شد. چک‌لیست­ محقق ساخته شامل اطلاعات دموگرافیک، مامایی، سیر لیبر و زایمان و عوارض مادری و نوزادی بود که در طول لیبر، حین زایمان، بلافاصله بعد از زایمان، 24 ساعت، 1 ماه، 1 ‌سال و 2 سال بعد از زایمان تکمیل گردید. تجزیه و تحلیل داده­ ها با استفاده از نرم‌افزار آماری SPSS (نسخه 25) و آزمون‌های رگرسیون لوجستیک و نسبت خطر انجام شد. میزان p کمتر از 05/0 معنادار در نظر گرفته شد.
یافته ­ها: مادران با پارگی کیسه آب در فاز نهفته نسبت به فاز فعال، موربیدیته بالاتری در 1 ماه اول پس از زایمان (76/0-32/0: CI 95%؛ 49/0=HR، 001/0=p) داشتند. عوارض نوزادی در دو بازه زمانی 24 ساعت اول (84/0-20/0: CI 95%؛ 41/0=HR، 015/0=p) و 1 ماه اول بعد از زایمان (71/0-04/0: CI 95%؛ 17/0=HR، 016/0=p) در گروه پارگی کیسه آب در فاز نهفته نسبت به فاز فعال بیشتر بود. با پارگی پرده ­ها در فاز نهفته، میزان زایمان سزارین و اپی‌زیاتومی 18/0 بیشتر بود.
نتیجه­ گیری: با افزایش طول مدت پارگی پرده ­ها، احتمال بروز عوارض بیشتر می­ شود، لذا کوتاه کردن مدت زمان زایمان در بارداری­ های ترم در پیشگیری از بروز عوارض، بهتر از مدیریت انتظاری است.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

The effect of rupture of membranes in two passive and active stages of labor on maternal and neonatal outcomes: A population-based prospective cohort study

نویسندگان [English]

  • Forouzan Olfati 1
  • Farnoosh Moafi 2
  • Zahra Hosseinkhani 3
  • Hamideh Hajnasiri 2
1 Associate Professor, Department of Midwifery, Social Determinants of Health Research Center, Non-Communicable Diseases Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
2 Instructor, Department of Midwifery, Social Determinants of Health Research Center, Non-Communicable Diseases Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
3 Assistant Professor, Department of Epidemiology and Biostatistics, Social Determinants of Health Research Center, Research Institute for Prevention of Non -communicable Disease, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran.
چکیده [English]

Introduction: Rupture of membrane (ROM) may occur before or after the onset of labor pains at any gestational age and cause maternal and neonatal consequences. The present study was conducted with aim to investigate the effect of the time of rupture of membranes on the short-and long-term outcomes of the mother and neonate.
Methods: This cohort study was conducted in 2017-2020 on 775 pregnant women with a gestational age of ≥37 weeks who met the inclusion criteria and had referred to Kosar Hospital in Qazvin for delivery. The researcher-made checklist included demographic, obstetrics, labor and delivery course, and maternal and neonatal complications, which was completed during labor, during delivery, immediately after delivery, 24 hours, 1 month, 1 year, and 2 years after delivery. Data analysis was performed using SPSS software (version 25) and logistic regression and risk ratio tests. P<0.05 was considered sttistically significant.
Results: Mothers with ROM in the latent phase compared to the active phase had higher morbidity in the first month after delivery (CI: 0.32-0.76; HR=0.49, P=0.001). Neonatal complications in the first 24 hours (CI: 0.20-0.84; HR=0.41, P=0.015) and in the first month after delivery (CI: 0.04-0.71; HR=0.17, P=0.016) was higher in the ROM group in the latent phase than in the active phase. With ROM in the latent phase, the rate of cesarean delivery and episiotomy was 0.18 higher.
Conclusion: With increase in the duration of ROM, the possibility of complications increases. Therefore, shortening the duration of delivery in term pregnancies is better than expectant management in preventing complications.

کلیدواژه‌ها [English]

  • Maternal outcome
  • Neonatal outcome
  • Premature rupture of membrane (PROM)

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مجله زنان، مامایی و نازایی ایران
دوره 28، شماره 1
فروردین 1404
صفحه 12-23

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