Department of Obstetrics and Gynaecology, Academic Medical Centre (AMC), Amsterdam, The Netherlands.
Department of Obstetrics and Gynaecology, Grow, School for Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
BJOG. 2021 Jan;128(2):292-301. doi: 10.1111/1471-0528.16115. Epub 2020 Mar 4.
To assess the effect of transabdominal amnioinfusion or no intervention on long-term outcomes in children born after second-trimester prelabour rupture of the membranes (PROM between 16 -24 weeks) and oligohydramnios.
Follow up of infants of women who participated in the randomised controlled trial: PPROMEXIL-III (NTR3492).
Surviving infants were invited for neurodevelopmental assessment up to 5 years of corrected age using a Bayley Scales of Infant and Toddler Development or a Wechsler Preschool and Primary Scale of Intelligence. Parents were asked to complete several questionnaires.
Neurodevelopmental outcomes were measured. Mild delay was defined as -1 standard deviation (SD), severe delay as -2 SD. Healthy long-term survival was defined as survival without neurodevelopmental delay or respiratory problems.
In the amnioinfusion group, 18/28 children (64%) died versus 21/28 (75%) in the no intervention group (relative risk 0.86; 95% confidence interval [CI] 0.60-1.22). Follow-up data were obtained from 14/17 (82%) children (10 amnioinfusion, 4 no intervention). In both groups, 2/28 (7.1%) had a mild neurodevelopmental delay. No severe delay was seen. Healthy long-term survival occurred in 5/28 children (17.9%) after amnioinfusion versus 2/28 (7.1%) after no intervention (odds ratio 2.50; 95% CI 0.53-11.83). When analysing data for all assessed survivors, 10/14 (71.4%) survived without mild neurodevelopmental delay and 7/14 (50%) were classified healthy long-term survivor.
In this small sample of women suffering second-trimester PROM and oligohydramnios, amnioinfusion did not improve long-term outcomes. Overall, 71% of survivors had no neurodevelopmental delay.
Healthy long-term survival was comparable for children born after second-trimester PROM and treatment with amnioinfusion or no intervention.
评估在妊娠中期胎膜早破（16-24 周之间）和羊水过少的情况下对第二产程前胎膜早破的儿童进行经腹羊膜腔输液或不干预对长期结局的影响。
随访参加随机对照试验的婴儿：PPROMEXIL-III（NTR3492）。
使用贝利婴幼儿发育量表或韦氏学前和小学智力量表对存活婴儿进行神经发育评估，直至校正年龄 5 岁。父母被要求完成几份问卷。
测量神经发育结果。轻度延迟定义为 -1 个标准差（SD），重度延迟定义为 -2 SD。健康的长期存活定义为无神经发育迟缓或呼吸问题的存活。
在羊膜腔输液组，28 名儿童中有 18 名（64%）死亡，而在未干预组有 21 名（75%）死亡（相对风险 0.86；95%置信区间 [CI] 0.60-1.22）。在 17 名儿童中的 14 名（82%）获得了随访数据（10 名羊膜腔输液，4 名未干预）。在两组中，2 名儿童（7.1%）有轻度神经发育迟缓。未发现重度延迟。羊膜腔输液组 5 名儿童（17.9%）长期健康存活，而未干预组 2 名儿童（7.1%）存活（比值比 2.50；95% CI 0.53-11.83）。当分析所有评估幸存者的数据时，14 名儿童中有 10 名（71.4%）无轻度神经发育迟缓存活，7 名（50%）被归类为长期健康幸存者。
在这一小部分患有妊娠中期胎膜早破和羊水过少的女性中，羊膜腔输液并未改善长期结局。总的来说，71%的幸存者没有神经发育迟缓。
在第二产程前胎膜早破的儿童中，与不干预相比，羊膜腔输液治疗并未改善长期结局。
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