LeMoine Felicia, Moore Robert C, Chapple Andrew, Moore Ferney A, Sutton Elizabeth
Department of Obstetrics and Gynecology, Louisiana State University Health Science Center, Baton Rouge, Louisiana.
Department of Maternal-Fetal Medicine, Woman's Hospital, Baton Rouge, Louisiana.
AJP Rep. 2020 Oct;10(4):e395-e402. doi: 10.1055/s-0040-1721421. Epub 2020 Dec 3.
To describe our hospital's experience following expectant management of previable preterm prelabor rupture of membranes (pPPROM). Retrospective review of neonatal survival and maternal and neonatal outcomes of pPPROM cases between 2012 and 2019 at a tertiary referral center in South Central Louisiana. Regression analyses were performed to identify predictors of neonatal survival. Of 81 cases of pPPROM prior to 23 weeks gestational age (WGA), 23 survived to neonatal intensive care unit discharge (28.3%) with gestational age at rupture ranging from 18 to 22 WGA. Increased latency (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI] = 1.11, 1.52) and increased gestational age at rupture (aOR = 1.62, 95% CI = 1.19, 2.21) increased the probability of neonatal survival. Antibiotics prior to delivery were associated with increased latency duration (adjusted hazard ratio = 0.55, 95% CI = 0.42, 0.74). Neonatal survival rate following pPPROM was 28.3%. Later gestational age at membrane rupture and increased latency periods are associated with increased neonatal survivability. Antibiotic administration following pPPROM increased latency duration.
描述我院对未达可存活孕周的早产前胎膜早破（pPPROM）进行期待治疗的经验。对2012年至2019年在路易斯安那州中南部一家三级转诊中心的pPPROM病例的新生儿存活情况以及母婴结局进行回顾性研究。进行回归分析以确定新生儿存活的预测因素。在孕周小于23周（WGA）的81例pPPROM病例中，23例存活至新生儿重症监护病房出院（28.3%），胎膜破裂时的孕周为18至22周WGA。潜伏期延长（调整后的优势比[aOR]=1.30，95%置信区间[CI]=1.11，1.52）和胎膜破裂时孕周增加（aOR=1.62，95%CI=1.19，2.21）增加了新生儿存活的概率。分娩前使用抗生素与潜伏期延长相关（调整后的风险比=0.55，95%CI=0.42，0.74）。pPPROM后的新生儿存活率为28.3%。胎膜破裂时孕周较大以及潜伏期延长与新生儿存活率增加相关。pPPROM后使用抗生素可延长潜伏期。
