Bouchet Noémie, Joal Arnaud, Gayet-Ageron Angèle, Areta Marina Lumbreras, Martinez de Tejada Begoña
Obstetrics Service, Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland.
Clinical Research Centre and Division of Clinical Epidemiology, Department of Community Health and Medicine, Geneva University Hospitals, Geneva, Switzerland.
J Perinat Med. 2019 Apr 24;47(3):341-346. doi: 10.1515/jpm-2018-0324.
Objectives To evaluate the number of late preterm (LPT) births (between 34 0/7 and 36 6/7 weeks) that could have been prevented if expectant management of preterm premature rupture of membranes (PPROM) had been applied according to new recommendations. Methods A retrospective cohort study included all births at one Swiss center between January 1, 2002 and December 31, 2012. Births were categorized using an adapted evidence-based classification. Two scenarios were considered: best scenario (maximum averted cases) and a conservative scenario (minimum averted cases). Results Among 2017 LPT births (5.0% of all deliveries; n=40,609), 1122 (60.6%) women had PPROM. Spontaneous labor occurred in 473 (42.2%) cases and 649 (57.8%) had induction of labor or an elective cesarean section. In the latter group, 44 (6.8%) had evidence-based indications for LPT delivery and 605 (83.2%) had non-evidence-based indications. Depending on the scenario, the rate of avoided LPT cases would have varied between 4.2% (95% confidence interval [CI]: 3.4-5.2) if the conservative scenario was applied, and 30% (95% CI: 28.0-32.0) for the best scenario. Conclusion Adoption of new guidelines for the management of PPROM will prevent a considerable number of LPT births and help decrease the adverse effects and potential disability associated with late preterm infants.
目的 评估如果按照新建议对早产胎膜早破（PPROM）进行期待管理，原本可以避免的晚期早产（LPT）（34⁰/₇至36⁶/₇周）分娩数量。方法 一项回顾性队列研究纳入了2002年1月1日至2012年12月31日期间在瑞士一个中心的所有分娩。使用经过调整的循证分类法对分娩进行分类。考虑了两种情况：最佳情况（最大避免病例数）和保守情况（最小避免病例数）。结果 在2017例晚期早产分娩中（占所有分娩的5.0%；n = 40,609），1122例（60.6%）妇女发生了PPROM。473例（42.2%）自然分娩，649例（57.8%）进行了引产或择期剖宫产。在后一组中，44例（6.8%）有晚期早产分娩的循证指征，605例（83.2%）有非循证指征。根据情况不同，如果采用保守情况，避免的晚期早产病例率在4.2%（95%置信区间[CI]：3.4 - 5.2）之间；如果采用最佳情况，则为30%（95% CI：28.0 - 32.0）。结论 采用PPROM管理新指南将避免相当数量的晚期早产分娩，并有助于减少与晚期早产儿相关的不良影响和潜在残疾。
