Mei-Dan Elad, Hutchison Zoe, Osmond Mark, Pakenham Susan, Ng Eugene, Green Jessica, Nevo Ori
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON; Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON; Department of Obstetrics and Gynecology, North York General Hospital, Toronto, ON; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON; Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON; Department of Obstetrics and Gynecology, North York General Hospital, Toronto, ON.
J Obstet Gynaecol Can. 2020 Feb;42(2):163-168. doi: 10.1016/j.jogc.2019.06.016. Epub 2019 Oct 31.
This study sought to compare the latency from membrane rupture to delivery and subsequent neonatal outcomes in twin gestations complicated by preterm premature rupture of membranes (PPROM) of the presenting versus non-presenting sac.
This was a retrospective study of twin pregnancies over a 7-year period diagnosed with PPROM between 12 and 37 weeks gestation with a latency period to delivery of >24 hours. The ruptured sac was identified by ultrasound scan. The study compared the latency period from PPROM to delivery and subsequent neonatal morbidity and mortality resulting from rupture of the presenting versus non-presenting sac. Obstetric and neonatal outcomes were evaluated using a matched-cohort subset analysis (Canadian Task Force Classification II-2).
During the study period, 77 twin pregnancies diagnosed with PPROM satisfied the inclusion criteria. The mean latency periods from PPROM to delivery were 10.1 days (n = 7) when the presenting sac ruptured and 41.3 days (n = 10) when the non-presenting sac ruptured (P < 0.05). Neonatal death was higher with PPROM of the presenting than the non-presenting sac (21.4% vs. 0%, respectively; P = 0.05). Neonates were more likely to be affected by retinopathy of prematurity (57% vs. 19%; P < 0.05) but less likely to have persistent pulmonary hypertension of the newborn (0% vs. 25%; P < 0.05) when the rupture occurred in the presenting sac. The rates of other neonatal adverse outcomes were similar between the two groups.
In twin gestations there is a longer latency from PPROM to delivery and fewer neonatal complications when rupture occurs in the non-presenting rather than the presenting sac.
本研究旨在比较双胎妊娠中，胎膜早破（PPROM）发生于先露胎膜与非先露胎膜时，从胎膜破裂到分娩的潜伏期以及随后的新生儿结局。
这是一项回顾性研究，研究对象为7年间诊断为PPROM的双胎妊娠，孕周在12至37周之间，分娩潜伏期>24小时。通过超声扫描确定破裂的胎膜囊。该研究比较了从PPROM到分娩的潜伏期，以及先露胎膜与非先露胎膜破裂后随后的新生儿发病率和死亡率。使用配对队列亚组分析（加拿大工作组分类II-2）评估产科和新生儿结局。
在研究期间，77例诊断为PPROM的双胎妊娠符合纳入标准。先露胎膜破裂时，从PPROM到分娩的平均潜伏期为10.1天（n = 7），非先露胎膜破裂时为41.3天（n = 10）（P < 0.05）。先露胎膜PPROM的新生儿死亡率高于非先露胎膜（分别为21.4%和0%；P = 0.05）。当破裂发生在先露胎膜时，新生儿更易患早产儿视网膜病变（57%比19%；P < 0.05），但患新生儿持续性肺动脉高压的可能性较小（0%比25%；P < 0.05）。两组其他新生儿不良结局的发生率相似。
在双胎妊娠中，PPROM发生于非先露胎膜而非先露胎膜时，从PPROM到分娩的潜伏期更长，新生儿并发症更少。
