Nakamura Eishin, Matsunaga Shigetaka, Ono Yoshihisa, Takai Yasushi, Seki Hiroyuki
Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, 350-8550, Saitama, Japan.
Department of Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
BMC Pregnancy Childbirth. 2020 Nov 3;20(1):662. doi: 10.1186/s12884-020-03366-0.
Determination of the optimal timing for termination of pregnancy in cases of preterm premature rupture of membranes (pPROM) during the extremely preterm period is still difficult. Bronchopulmonary dysplasia (BPD) is a major disease widely taken into account when determining the prognosis of respiratory disorders in a neonate. Many aspects of this disease remain unclear. With the aim of further improving the prognosis of neonates born to mothers with pPROM, this study examined cases who were diagnosed with pPROM before 28 weeks of gestation. The study analysed risk factors for neonatal BPD.
This study included 73 subjects with singleton pregnancy, diagnosed with pPROM during the gestational period from 22 weeks and 0 days to 27 weeks and 6 days. The following factors were retrospectively examined: the gestational week at which pPROM was diagnosed, the gestational week at which delivery occurred, the period for which the volume of amniotic fluid was maintained, and neonatal BPD as a complication. Receiver operating characteristic (ROC) curve analyses were conducted to analyse the relationship of the onset of BPD with the duration of oligohydramnios and the gestational weeks of delivery.
The mean gestational week at which a diagnosis of amniorrhexis was made was 24.5 ± 1.9 weeks (mean ± SD), and that at which delivery occurred was 27.0 ± 3.0 weeks. Fifty-seven cases (78.1%) were diagnosed with oligohydramnios, the mean duration of which was 17.4 ± 20.5 days. The mean birth weight of neonates was 1000 ± 455 g, of which 49 (67.1%) were diagnosed with BPD following birth. No neonates died in this study. The ROC curve indicated that the cut-off values for the duration of oligohydramnios and gestational age at delivery were 4 days and 24.1 weeks, respectively. Multivariate analysis indicated that the duration of oligohydramnios for more than 4 days before delivery and preterm delivery at less than 24.1 weeks were risk factors for the onset of BPD.
Our findings suggest that duration of oligohydramnios for more than 4 days before delivery and preterm delivery less than 24.1 weeks are risk factors for BPD in cases who are diagnosed with pPROM before 28 weeks of gestation.
确定极早早产胎膜早破（pPROM）病例的最佳终止妊娠时机仍然困难。支气管肺发育不良（BPD）是在评估新生儿呼吸系统疾病预后时广泛考虑的一种主要疾病。该疾病的许多方面仍不清楚。为了进一步改善pPROM母亲所生新生儿的预后，本研究调查了妊娠28周前被诊断为pPROM的病例。该研究分析了新生儿BPD的危险因素。
本研究纳入了73名单胎妊娠的受试者，他们在妊娠22周0天至27周6天期间被诊断为pPROM。回顾性研究了以下因素：诊断pPROM时的孕周、分娩时的孕周、羊水维持的时间以及作为并发症的新生儿BPD。进行了受试者工作特征（ROC）曲线分析，以分析BPD的发病与羊水过少持续时间和分娩孕周之间的关系。
诊断胎膜早破时的平均孕周为24.5±1.9周（均值±标准差），分娩时的平均孕周为27.0±3.0周。57例（78.1%）被诊断为羊水过少，平均持续时间为17.4±20.5天。新生儿的平均出生体重为1000±455g，其中49例（67.1%）出生后被诊断为BPD。本研究中无新生儿死亡。ROC曲线表明，羊水过少持续时间和分娩时孕周的截断值分别为4天和24.1周。多因素分析表明，分娩前羊水过少持续时间超过4天和孕周小于24.1周的早产是BPD发病的危险因素。
我们的研究结果表明，分娩前羊水过少持续时间超过4天和孕周小于24.1周的早产是妊娠28周前被诊断为pPROM病例发生BPD的危险因素。
