Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Tel Aviv University, Israel.
Am J Obstet Gynecol. 2011 Jan;204(1):48.e1-8. doi: 10.1016/j.ajog.2010.08.021. Epub 2010 Nov 11.
We sought to compare neonatal outcome in cases of uncomplicated preterm premature rupture of membranes (PPROM) (ie, no evidence of clinical chorioamnionitis, placental abruption, or fetal distress) with that of spontaneous preterm deliveries (PTDs) and to determine the effect of the latency period.
The study group included women with PPROM at gestational age 28⁰(/)⁷-33⁶(/)⁷ weeks (n = 488). Neonatal outcome was compared with a matched control group of women with spontaneous PTD (n = 1464).
Neonates in the uncomplicated PPROM group were at increased risk for composite adverse outcome (53.7% vs 42.0%; P < .001), mortality (1.6% vs 0.0%; P < .001), respiratory morbidity (32.8% vs 26.4%; P = .006), necrotizing enterocolitis, jaundice, hypoglycemia, hypothermia, and polycythemia. Neonatal adverse outcome was more likely in cases of latency period >7 days, oligohydramnios, male fetus, and nulliparity.
Consultation regarding prematurity-related morbidity in infants exposed to uncomplicated PPROM cannot be extrapolated from PTDs and should be stratified by the duration of the latency period and the other risk factors identified in the current study.
本研究旨在比较单纯早产胎膜早破（PPROM）（即无临床绒毛膜羊膜炎、胎盘早剥或胎儿窘迫证据）与自发性早产（PTD）的新生儿结局，并确定潜伏期的影响。
研究组纳入了妊娠 28⁰（/）⁷-33⁶（/）⁷ 周的单纯 PPROM 产妇（n=488）。将新生儿结局与自发性 PTD 产妇的匹配对照组（n=1464）进行比较。
单纯 PPROM 组新生儿发生复合不良结局的风险增加（53.7% vs. 42.0%；P<.001）、死亡率（1.6% vs. 0.0%；P<.001）、呼吸窘迫发生率（32.8% vs. 26.4%；P=.006）、坏死性小肠结肠炎、黄疸、低血糖、低体温和红细胞增多症。潜伏期>7 天、羊水过少、男性胎儿和初产妇更易发生新生儿不良结局。
不能将单纯 PPROM 暴露婴儿的与早产相关发病率的咨询结果外推至 PTD，应根据潜伏期的持续时间和本研究中确定的其他风险因素进行分层。
