Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Obstet Gynecol. 2014 Aug;124(2 Pt 1):323-331. doi: 10.1097/AOG.0000000000000369.
To describe the perinatal and infant and early childhood morbidity associated with preterm premature rupture of membranes (PROM) in a cohort of twin pregnancies evaluated prospectively with neonatal follow-up to 2 years of age.
This was a secondary analysis of a randomized controlled trial of magnesium sulfate for prevention of cerebral palsy. Inclusion criteria were twin gestation with preterm PROM diagnosed between 24 0/7 and 31 6/7 weeks of gestation and planned expectant management. Latency (time from membrane rupture to delivery) and perinatal outcomes were evaluated by gestational age at membrane rupture. Long-term neonatal outcomes were also analyzed.
Among 151 women who met inclusion criteria, the median gestational age at preterm PROM was 28.1 weeks (range 24.1-31.6 weeks). Approximately one-third of women achieved a latency of at least 1 week. Gestational age at preterm PROM (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.63-0.90 for each week after 24 weeks of gestation) and cervical dilation at admission (OR 0.66, 95% CI 0.49-0.90 for each centimeter of dilation) were inversely associated with a latency period of at least 1 week. There were no stillbirths (95% CI 0-1%), but the rate of neonatal mortality was 90 per 1,000 newborns (95% CI 57-112) with a 7.3% cerebral palsy rate among survivors (95% CI 4.4-10.3%).
In twin pregnancies, preterm PROM from 24 to 31 weeks of gestation is associated with a neonatal mortality rate of 9.0% and an overall cerebral palsy rate of 7.3%. A longer latency period is associated with less advanced cervical dilation and later gestational age at PROM. LEVEL OF EVIEDENCE: II.
描述前瞻性评估的双胞胎妊娠中与早产胎膜早破（PPROM）相关的围产期和婴儿及幼儿发病率，并对新生儿进行随访至 2 岁。
这是一项硫酸镁预防脑瘫的随机对照试验的二次分析。纳入标准为妊娠 24 0/7 至 31 6/7 周诊断为双胎妊娠且计划期待治疗的 PPROM。潜伏期（胎膜破裂至分娩的时间）和围产期结局按胎膜破裂时的胎龄评估。还分析了长期新生儿结局。
在符合纳入标准的 151 名妇女中，早产胎膜早破的中位胎龄为 28.1 周（范围 24.1-31.6 周）。约三分之一的妇女实现了至少 1 周的潜伏期。早产胎膜早破时的胎龄（每增加 1 周，优势比 [OR] 0.75，95%置信区间 [CI] 0.63-0.90）和入院时的宫颈扩张（每增加 1 厘米，OR 0.66，95% CI 0.49-0.90）与至少 1 周的潜伏期呈负相关。无死胎（95%CI 0-1%），但新生儿死亡率为 900/1000 活产儿（95%CI 57-112），幸存者脑瘫发生率为 7.3%（95%CI 4.4-10.3%）。
在双胞胎妊娠中，24 至 31 周的早产胎膜早破与 9.0%的新生儿死亡率和 7.3%的总体脑瘫发生率相关。较长的潜伏期与宫颈扩张程度较低和胎膜早破时胎龄较晚相关。
II。
