Sim Winnie Huiyan, Ng Hamon, Sheehan Penelope
Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia.
Pregnancy Research Centre, Royal Women's Hospital, Melbourne, VIC, Australia.
J Matern Fetal Neonatal Med. 2020 Feb;33(4):533-541. doi: 10.1080/14767058.2018.1495706. Epub 2018 Aug 13.
To provide center-based outcome data on obstetric and neonatal complications arising from expectantly managed pregnancies affected by preterm prelabor rupture of membranes (PPROM) before viability. We collected data on 130 consecutive pregnancies complicated by spontaneous rupture of membranes before 24 week's gestation, occurring over a 7-year period. These were women who delivered >24 h after membrane rupture, and had no signs of chorioamnionitis or advanced labor at admission. Women with amniocentesis-induced PPROM ( = 7) were analyzed separately. The descriptive statistics of obstetrics and neonatal outcomes were reported. The overall neonatal survival to discharge rate was 33.8%. Stratification of patients into early (12 to 19 weeks' gestation) and late pre-viable PPROM (20 to 23 weeks' gestation) revealed a 3.6-fold increase in survival rate in the latter group (12.2% versus 43.8%, < .001). Pre-viable PPROM following amniocentesis predicted a 100% survival outcome, however anhydramnios impacted negatively. The most common neonatal morbidities of those admitted to intensive care unit were respiratory distress syndrome (78.7%) and bronchopulmonary dysplasia (84.4%). The most common maternal morbidities affecting pre-viable PPROM were clinical chorioamnionitis (47.7%), histological chorioamnionitis (81.8%), retained products of conception (39.3%) and preterm labor (45.4%). Later gestational ages at PPROM were associated with better survival rates, however neonatal morbidity remained high. Women experiencing pre-viable PPROM following amniocentesis can be reassured, while those with anhydramnios at any time during the latency period should be adequately counseled regarding poorer outcomes.
提供关于未达到生存能力前期待治疗的胎膜早破（PPROM）妊娠所引发的产科和新生儿并发症的中心结局数据。我们收集了在7年期间内连续130例妊娠24周前胎膜自发破裂的病例数据。这些产妇在胎膜破裂后24小时以上分娩，入院时无绒毛膜羊膜炎或临产进展迹象。羊水穿刺诱发PPROM的女性（n = 7）单独分析。报告了产科和新生儿结局的描述性统计数据。新生儿总体出院存活率为33.8%。将患者分为妊娠早期（12至19周）和未达到生存能力晚期PPROM（20至23周），结果显示后一组的存活率提高了3.6倍（12.2%对43.8%，P <.001）。羊水穿刺后未达到生存能力的PPROM预测100%存活结局，但羊水过少有负面影响。入住重症监护病房的新生儿最常见的疾病是呼吸窘迫综合征（78.7%）和支气管肺发育不良（84.4%）。影响未达到生存能力PPROM的最常见产妇疾病是临床绒毛膜羊膜炎（47.7%）、组织学绒毛膜羊膜炎（81.8%）、妊娠物残留（39.3%）和早产（45.4%）。PPROM时孕周较大与存活率较高相关，但新生儿发病率仍然很高。羊水穿刺后经历未达到生存能力PPROM的女性可以放心，但潜伏期内任何时候出现羊水过少的女性应就较差的结局得到充分咨询。
