Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, PO Box 8905, NO-7491, Trondheim, Norway.
Department of Obstetrics and Gynecology, Helse More og Romsdal HF, Alesund, Norway.
BMC Pregnancy Childbirth. 2020 Jan 31;20(1):67. doi: 10.1186/s12884-020-2751-3.
Guidelines regarding management of prelabor rupture of membranes (PROM) at term vary between immediate induction and expectant management. A long interval between PROM and delivery increases the risk for perinatal infections. Severe perinatal infections are associated with excess risk for cerebral palsy (CP) and perinatal death. We investigated if increasing intervals between PROM and delivery were associated with perinatal death or CP.
Eligible to participate in this population-based cohort-study were term born singletons without congenital malformations born in Norway during 1999-2009. Data was retrieved from the Medical Birth Registry of Norway (MBRN) and the Cerebral Palsy Register of Norway. In line with the registration in the MBRN, intervals between PROM and delivery of more than 24 h was defined as 'prolonged' and intervals between 12 and 24 h as 'intermediate'. Outcomes were stillbirth, death during delivery, neonatal mortality and CP. Logistic regression was used to calculate odds ratio (OR) with 95% confidence intervals (CI) for adverse outcomes in children born after prolonged and intermediate intervals, compared with a reference group comprising all children born less than 12 h after PROM or without PROM.
Among 559,972 births, 34,759 children were born after intermediate and 30,332 were born after prolonged intervals. There was no association between increasing intervals and death during delivery or in the neonatal period, while the prevalence of stillbirths decreased with increasing intervals. Among children born after intermediate intervals 38 (0.11%) had CP, while among those born after prolonged intervals 46 (0.15%) had CP. Compared with the reference group, the OR for CP was 1.16 (CI; 0.83 to 1.61) after intermediate and 1.61 (CI; 1.19 to 2.18) after prolonged intervals. Adjusting for antenatal factors did not affect these associations. Among children with CP the proportion with diffuse cortical injury and basal ganglia pathology on cerebral MRI, consistent with hypoxic-ischemic injuries, increased with increasing intervals.
Intervals between PROM and delivery of more than 24 h were associated with CP, but not with neonatal mortality or death during delivery. The inverse association with stillbirth is probably due to reverse causality.
关于足月胎膜早破（PROM）管理的指南在即刻引产和期待治疗之间存在差异。PROM 与分娩之间的时间间隔延长会增加围产期感染的风险。严重的围产期感染与脑瘫（CP）和围产儿死亡的风险增加有关。我们研究了 PROM 与分娩之间的时间间隔延长是否与围产儿死亡或 CP 有关。
本基于人群的队列研究纳入了 1999 年至 2009 年期间在挪威出生的无先天性畸形的足月单胎儿。数据来自挪威医学出生登记处（MBRN）和挪威脑瘫登记处。根据 MBRN 的登记，PROM 与分娩之间超过 24 小时的时间间隔被定义为“延长”，12 至 24 小时之间的时间间隔为“中间”。结局为死产、分娩期间死亡、新生儿死亡和 CP。使用逻辑回归计算延长和中间间隔后出生的儿童与所有 PROM 后 12 小时内或无 PROM 后出生的儿童相比，不良结局的比值比（OR）及其 95%置信区间（CI）。
在 559972 例分娩中，34759 例儿童分娩于中间间隔，30332 例分娩于延长间隔。随着间隔时间的增加，分娩期间或新生儿期的死亡没有相关性，而死产的发生率则随着间隔时间的增加而下降。在分娩于中间间隔的儿童中，有 38 例（0.11%）患有 CP，而在分娩于延长间隔的儿童中，有 46 例（0.15%）患有 CP。与参考组相比，中间间隔组的 CP 比值比（OR）为 1.16（CI；0.83 至 1.61），延长间隔组的 OR 为 1.61（CI；1.19 至 2.18）。调整产前因素并未影响这些关联。在 CP 患儿中，大脑 MRI 上弥漫性皮质损伤和基底节病变的比例（与缺氧缺血性损伤一致）随间隔时间的延长而增加。
PROM 与分娩之间的时间间隔大于 24 小时与 CP 有关，但与新生儿死亡率或分娩期间的死亡率无关。与死产呈负相关可能是由于反向因果关系。
