Obstet Gynecol. 2020 Mar;135(3):739-743. doi: 10.1097/AOG.0000000000003701.
Preterm birth occurs in approximately 10% of all births in the United States and is a major contributor to perinatal morbidity and mortality (). Prelabor rupture of membranes (PROM) that occurs preterm complicates approximately 2-3% of all pregnancies in the United States, representing a significant proportion of preterm births, whereas term PROM occurs in approximately 8% of pregnancies (). The optimal approach to assessment and treatment of women with term and preterm PROM remains challenging. Management decisions depend on gestational age and evaluation of the relative risks of delivery versus the risks (eg, infection, abruptio placentae, and umbilical cord accident) of expectant management when pregnancy is allowed to progress to a later gestational age. The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented. This Practice Bulletin is updated to include information about diagnosis of PROM, expectant management of PROM at term, and timing of delivery for patients with preterm PROM between 34 0/7 weeks of gestation and 36 6/7 weeks of gestation.
早产在美国约占所有分娩的 10%，是围产期发病率和死亡率的主要原因（）。早产时发生的胎膜早破（PROM）约占美国所有妊娠的 2-3%，占早产的很大比例，而足月时发生的 PROM 约占妊娠的 8%（）。对于足月和早产 PROM 的妇女，评估和治疗的最佳方法仍然具有挑战性。管理决策取决于胎龄，并评估分娩的相对风险与允许妊娠进展到较晚胎龄时的风险（例如感染、胎盘早剥和脐带意外）。本文件的目的是回顾对这种情况的现有认识，并提供管理指南，这些指南在有条件进行基于结果的研究时已得到验证。此外，还根据共识和专家意见提出了其他指南。本实践公告已更新，包括关于 PROM 诊断、足月 PROM 的期待治疗以及 34 0/7 周至 36 6/7 周之间的早产 PROM 患者分娩时机的信息。
