From the Department of Obstetrics and Gynecology, Stanford University, Stanford, California; the Department of Neonatology, University of California, San Francisco, San Francisco, California; the Department of Neonatology, Stanford University, Stanford, California; California Perinatal Quality Care Collaborative, Palo Alto, California.
Obstet Gynecol. 2010 Dec;116(6):1381-1386. doi: 10.1097/AOG.0b013e3181fe3d28.
To estimate the effect of preterm premature rupture of membranes (PROM) on neonatal mortality.
A cross-sectional study using a state perinatal database (California Perinatal Quality Care Collaborative) was performed. Prenatal data, including ruptured membranes, corticosteroid administration, maternal age, maternal race, maternal hypertension, mode of delivery, and prenatal care, were recorded. Mortality rates were compared for neonates born between 24 and 34 weeks of gestation without preterm PROM to those with recent (less than 18 hours before delivery) and prolonged (more than 18 hours before delivery) preterm PROM. Neonatal sepsis rates were also examined.
Neonates born between 24 0/7 and 34 0/7 weeks of gestation from 127 California neonatal intensive care units between 2005 and 2007 were included (N=17,501). When analyzed by 2-week gestational age groups, there were no differences in mortality rates between those born with and without membrane rupture before delivery. The presence of prolonged preterm PROM was associated with decreased mortality at 24 to 26 weeks of gestation (18% compared with 31% for recent preterm PROM; odds ratio [OR] 1.79; confidence interval [CI] 1.25-2.56) but increased mortality at 28 to 30 weeks of gestation (4% compared with 3% for recent preterm PROM; OR 0.44; CI 0.22, 0.88) when adjusted for possible confounding factors. Sepsis rates did not differ between those with recent or prolonged preterm PROM at any gestational age.
The presence of membrane rupture before delivery was not associated with increased neonatal mortality in any gestational age group. The effects of a prolonged latency period were not consistent across gestational ages.
评估胎膜早破（PROM）对新生儿死亡率的影响。
采用横断面研究，使用州围产期数据库（加利福尼亚围产期优质护理协作）进行。记录产前数据，包括胎膜破裂、皮质类固醇给药、产妇年龄、产妇种族、产妇高血压、分娩方式和产前护理。比较胎龄 24 至 34 周之间无早产 PROM 的新生儿与近期（分娩前 18 小时内）和延长（分娩前 18 小时以上）早产 PROM 的新生儿的死亡率。还检查了新生儿败血症的发生率。
纳入了 2005 年至 2007 年加利福尼亚 127 家新生儿重症监护病房胎龄为 240/7 至 340/7 周的新生儿（N=17501）。按 2 周胎龄组分析，分娩前胎膜破裂与无胎膜破裂的新生儿死亡率无差异。延长的早产 PROM 与 24 至 26 周时的死亡率降低相关（近期早产 PROM 为 31%，而延长的早产 PROM 为 18%；比值比[OR]1.79；95%置信区间[CI]1.25-2.56），但 28 至 30 周时的死亡率增加（近期早产 PROM 为 3%，而延长的早产 PROM 为 4%；OR 0.44；95%CI 0.22，0.88），在调整了可能的混杂因素后。近期或延长的早产 PROM 的新生儿败血症发生率在任何胎龄组均无差异。
分娩前胎膜破裂与任何胎龄组的新生儿死亡率增加无关。潜伏期延长的影响在不同胎龄组不一致。
