Pasquier J-C, Doret M
Département de gynécologie-obstétrique, faculté de médecine, université de Sherbrooke, Sherbrooke, Qc J1H 5N4, Canada.
J Gynecol Obstet Biol Reprod (Paris). 2008 Oct;37(6):568-78. doi: 10.1016/j.jgyn.2007.11.031. Epub 2008 May 16.
Preterm premature rupture of the membranes (PPROM) begins a high-risk period for both mother and fetus. This literature review updates the knowledge on latency-period complications and proposed monitoring strategies. Four latency-period complications are described: spontaneous onset of labor, infection (chorioamnionitis), abruptio placentae, and fetal, distress which can be linked to umbilical cord prolapse. Admittedly, the infection/inflammation process plays a key role during the latency period. Conservative management of PPROM is recommended and is associated with significant pregnancy prolongation. This strategy allows a gain in fetal maturity, but increases the risk of complications. The prediction of infection seems to be essential; classical markers, such as blood count and reactive C protein are not very effective. New markers have been tested, with IL-6 appearing to be one of the best infection markers. Fetal pulmonary maturity can be evaluated with a rapid screening test and can yield arguments for the management strategy.
胎膜早破(PPROM)会开启母婴均处于高风险的时期。这篇文献综述更新了关于潜伏期并发症及建议监测策略的知识。文中描述了四种潜伏期并发症:自然临产、感染(绒毛膜羊膜炎)、胎盘早剥以及可能与脐带脱垂相关的胎儿窘迫。诚然,感染/炎症过程在潜伏期起着关键作用。推荐对PPROM进行保守治疗,这与显著延长孕周相关。该策略有助于胎儿成熟,但会增加并发症风险。感染的预测似乎至关重要;传统指标,如血细胞计数和C反应蛋白,效果并不理想。已对新指标进行了测试,白细胞介素-6似乎是最佳感染指标之一。可通过快速筛查试验评估胎儿肺成熟度,这可为管理策略提供依据。