Qublan H S, Malkawi H Y, Hiasat M S, Hindawi I M, Al-Taani M I, Abu-Khait S A, Al-Maaitah J F
Clin Exp Obstet Gynecol. 2001;28(3):183-6.
This study was carried out to examine the effect of antenatal corticosteroid therapy on pregnancies complicated by premature rupture of membranes (PROMs). For this purpose, 139 patients with a singleton pregnancy (27-34 weeks of gestation) complicated by PROMs were evaluated prospectively during the period January 1997 to February 1999 at two Jordanian military hospitals (Prince Rhashed and Prince Zaid). Patients were allocated into two groups; Group 1 included 72 patients treated with dexamethsone (24 mg divided into 4 doses 12 hours apart), and Group 2 which included 67 patients whoreceived no treatment (control group). All women were examined clinically and the diagnosis of PROMs was demonstrated using vaginal speculum, nitrazine paper examination and ultrasonography. All neonates were evaluated clinically, radiologically, and by laboratory investigations. Pearson's Chi-square and Fisher's exact tests were used to assess the significance of differences between the two study groups. Respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), intraventricular haemorrhage (IVH), and days of hospital stay were significantly reduced in premature infants of the corticosteroid treated women compared with the controls (p<0.04, p<0.04, p<0.04, and p<0.05, respectively). The perinatal mortality was significantly decreased among the corticosteroid treated group in the gestational subgroups 31-32 and 33-34 weeks (p<0.04), and in all birth weight subgroups (p<0.03). RDS was statistically a significant factor which resulted in increased perinatal mortality in the control group (p=0.02). Regarding the occurrence of postpartum endometritis there was a statistically significant increase among the corticosteroid treated group compared with the controls (p<0.04).
Antenatal corticosteroid therapy in pregnancies complicated by PROMs has a positive influencing effect on premature infants between 31 and 34 weeks of gestation, decreasing significantly the perinatal morbidity and mortality. It should be used with particular relevance to the developing world where surfactant is not available or where neonatal intensive care units are lacking.
本研究旨在探讨产前使用糖皮质激素治疗对胎膜早破（PROMs）合并妊娠的影响。为此，1997年1月至1999年2月期间，在约旦的两家军队医院（拉希德王子医院和扎伊德王子医院）对139例单胎妊娠（孕27 - 34周）合并胎膜早破的患者进行了前瞻性评估。患者被分为两组；第1组包括72例接受地塞米松治疗的患者（24毫克分为4剂，每12小时一剂），第2组包括67例未接受治疗的患者（对照组）。所有女性均进行了临床检查，并通过阴道窥器、石蕊试纸检查和超声检查证实了胎膜早破的诊断。所有新生儿均进行了临床、放射学和实验室检查。采用Pearson卡方检验和Fisher精确检验来评估两组研究对象之间差异的显著性。与对照组相比，接受糖皮质激素治疗的孕妇所生早产儿的呼吸窘迫综合征（RDS）、坏死性小肠结肠炎（NEC）、脑室内出血（IVH）及住院天数均显著减少（分别为p<0.04、p<0.04、p<0.04和p<0.05）。在31 - 32周和33 - 34周的孕周亚组以及所有出生体重亚组中，糖皮质激素治疗组的围产儿死亡率显著降低（p<0.04和p<0.03）。RDS在统计学上是导致对照组围产儿死亡率增加的一个显著因素（p = 0.02）。关于产后子宫内膜炎的发生率，与对照组相比，糖皮质激素治疗组有统计学意义的增加（p<0.04）。
对于胎膜早破合并妊娠，产前糖皮质激素治疗对孕31至34周的早产儿有积极影响，显著降低围产儿发病率和死亡率。在没有表面活性剂或缺乏新生儿重症监护病房的发展中世界，尤其应使用该治疗方法。
