Storness-Bliss Claudine, Metcalfe Amy, Simrose Rebecca, Wilson R Douglas, Cooper Stephanie L
Faculty of Medicine, University of Calgary, Calgary AB.
Community Health Sciences, University of Calgary, Calgary AB.
J Obstet Gynaecol Can. 2012 Feb;34(2):154-158. doi: 10.1016/S1701-2163(16)35158-1.
To correlate maternal and fetal outcomes of pregnancies affected by preterm premature rupture of membranes (PPROM) at < 24 weeks' gestational age with the amount of residual amniotic fluid as determined by sonographic evaluation.
We searched the local maternal-fetal medicine database for the records of all women with PPROM prior to 24 completed weeks of pregnancy. The quantity of residual amniotic fluid determined by ultrasound was recorded and women were separated into two groups: (A) deepest vertical pocket (DVP) ≥ 1 cm, or (B) DVP < 1 cm (severe oligohydramnios). Hospital chart review was undertaken to determine latency to delivery, perinatal death, and maternal complications. Data were analyzed using Fisher exact and Wilcoxon-Mann-Whitney U tests.
We identified 31 subjects, of whom nine elected termination of pregnancy (6 in group A, 3 in group B). Six of 10 subjects in group A had a live delivery without neonatal death, whereas only one of 12 subjects in group B had a live delivery (P = 0.020). Additional complications included placental abruption in 63% in group A and 45% in group B, chorioamnionitis in 50% and 70%, respectively, and postpartum endometritis in 0% and 9%, respectively. None of these differences were statistically significant. There were no cases of maternal sepsis or maternal death in either group. Group A was associated with a later GA at delivery (27.5 weeks vs. 23 weeks, P = 0.07), with the GA at rupture of the membranes similar for both groups.
These results indicate that a higher level of residual amniotic fluid after periviable PPROM is associated with fetal survival and increased latency to delivery without an increase in maternal complications. This information will be valuable in counselling pregnant women with PPROM < 24 weeks.
将孕龄小于24周的胎膜早破（PPROM）孕妇的母儿结局与超声评估所确定的残余羊水量相关联。
我们在本地母胎医学数据库中搜索了所有妊娠满24周前发生PPROM的女性记录。记录超声测定的残余羊水量，并将女性分为两组：（A）最深垂直羊水池（DVP）≥1cm，或（B）DVP＜1cm（严重羊水过少）。进行医院病历审查以确定分娩潜伏期、围产儿死亡和母体并发症。使用Fisher精确检验和Wilcoxon-Mann-Whitney U检验分析数据。
我们确定了31名受试者，其中9人选择终止妊娠（A组6人，B组3人）。A组10名受试者中有6名活产且无新生儿死亡，而B组12名受试者中只有1名活产（P = 0.020）。其他并发症包括A组63%和B组45%发生胎盘早剥，分别有50%和70%发生绒毛膜羊膜炎，分别有0%和9%发生产后子宫内膜炎。这些差异均无统计学意义。两组均无母体败血症或母体死亡病例。A组分娩时的孕龄较晚（27.5周对23周，P = 0.07），两组胎膜破裂时的孕龄相似。
这些结果表明，可存活孕周前发生PPROM后较高水平的残余羊水与胎儿存活及分娩潜伏期延长相关，且母体并发症未增加。该信息对于为孕龄小于24周的PPROM孕妇提供咨询将很有价值。
