Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
Department of Anesthesia, Stanford University School of Medicine, Stanford, California.
Am J Perinatol. 2015 May;32(6):537-44. doi: 10.1055/s-0034-1396690. Epub 2014 Dec 29.
The aim of this article is to determine the risk of maternal chorioamnionitis and neonatal morbidity in women with preterm premature rupture of membranes (PPROM) exposed to one corticosteroid course versus a single repeat corticosteroid steroid course.
Secondary analysis of a cohort of women with singleton pregnancies and PPROM. The primary outcome was a clinical diagnosis of maternal chorioamnionitis. Using multivariate logistic regression, we controlled for maternal age, race, body mass index, diabetes, gestational age at membrane rupture, preterm labor, and antibiotic administration. Neonatal morbidities were compared between groups controlling for gestational age at delivery.
Of 1,652 women with PPROM, 1,507 women received one corticosteroid course and 145 women received a repeat corticosteroid course. The incidence of chorioamnionitis was similar between groups (single course = 12.3% vs. repeat course = 11.0%; p = 0.8). Women receiving a repeat corticosteroid course were not at increased risk of chorioamnionitis (adjusted odds ratio, 1.28; 95% confidence interval, 0.69-2.14). A repeat course of steroids was not associated with an increased risk of any neonatal morbidity.
Compared with a single steroid course, our findings suggest that the risk of maternal chorioamnionitis or neonatal morbidity may not be increased for women with PPROM receiving a repeat corticosteroid course.
本文旨在确定接受单剂皮质类固醇与重复一剂皮质类固醇治疗的胎膜早破（PPROM）孕妇发生绒毛膜羊膜炎和新生儿发病率的风险。
对单胎妊娠和 PPROM 孕妇队列进行二次分析。主要结局为产妇绒毛膜羊膜炎的临床诊断。采用多变量逻辑回归，我们控制了产妇年龄、种族、体重指数、糖尿病、胎膜破裂时的孕周、早产和抗生素的使用。在控制分娩时的胎龄的情况下，比较了两组之间的新生儿发病率。
在 1652 名 PPROM 孕妇中，1507 名接受了单剂皮质类固醇治疗，145 名接受了重复皮质类固醇治疗。两组绒毛膜羊膜炎的发生率相似（单剂组为 12.3%，重复组为 11.0%；p=0.8）。接受重复皮质类固醇治疗的孕妇患绒毛膜羊膜炎的风险没有增加（调整后的优势比，1.28；95%置信区间，0.69-2.14）。重复使用类固醇与任何新生儿发病率的增加均无关。
与单剂类固醇治疗相比，我们的研究结果表明，接受重复皮质类固醇治疗的 PPROM 孕妇发生绒毛膜羊膜炎或新生儿发病率的风险可能不会增加。
