J Obstet Gynecol Neonatal Nurs. 2021 Mar;50(2):122-132. doi: 10.1016/j.jogn.2020.10.010. Epub 2021 Jan 23.
To assess rates of induction/augmentation of labor, maternal infection, neonatal outcomes, and time to birth when women were expectantly managed after term prelabor rupture of membranes (PROM) at home or in the hospital.
Retrospective, descriptive study based on a review of data from a hospital midwifery service database and chart review.
A large Midwest hospital with 4,700 births annually.
We used the cases of women who received midwifery care, experienced term PROM, and had singleton fetuses in the vertex position.
We conducted an analysis of maternal and neonatal outcomes with term PROM using data from a midwifery service quality improvement database. We compared characteristics and outcomes between management plans (immediate induction, expectant hospital, and expectant home) using chi-square, analysis of variance, and independent t-tests.
PROM occurred in 281 (12%) of the 2,357 women cared for by the midwifery service between January 2016 and December 2018. One hundred fifty women (53.3%) opted to wait for labor onset at home, 102 (36.3%) were expectantly managed in the hospital, 21 (7.5%) were admitted for immediate induction of labor, and 8 (2.8%) were admitted for immediate cesarean birth. The rate of spontaneous labor onset was not significantly different between the two expectant management groups or between nulliparous and multiparous women. A total of 88 (34.9%) women who were expectantly managed ultimately had their labors induced. Rates of chorioamnionitis and endometritis were not significantly different between the expectant management groups in this study or compared with national averages. There was no difference in NICU admissions or Apgar scores below 7. The mean time from PROM to birth was significantly shorter in the expectant management in hospital group (27.3 hours) than in the expectant management at home group (33.5 hours).
Expectant management at home or in the hospital is appropriate for low-risk pregnant women with term PROM. Women for whom this option is appropriate include those with term singleton fetuses in vertex presentation with reassuring fetal heart rates and confirmed clear amniotic fluid. Acceptable time frames for home management include up to 24 hours for women with negative group B streptococcus cultures and up to 12 hours for those with positive cultures.
评估足月胎膜早破（PROM）孕妇在家或医院期待管理后的引产/催产率、产妇感染率、新生儿结局和分娩时间。
基于医院助产服务数据库和病历回顾数据的回顾性描述性研究。
一家拥有每年 4700 例分娩量的中西部大型医院。
我们纳入了接受助产服务、足月 PROM 且胎先露为头位的单胎孕妇。
我们使用助产服务质量改进数据库中的数据，对足月 PROM 孕妇的母婴结局进行了分析。我们通过卡方检验、方差分析和独立 t 检验比较了不同管理方案（立即引产、期待医院管理和期待家庭管理）的特征和结局。
2016 年 1 月至 2018 年 12 月，共有 2357 名接受助产服务的孕妇中，281 名（12%）发生 PROM。150 名（53.3%）孕妇选择在家等待自然临产，102 名（36.3%）在医院期待管理，21 名（7.5%）入院立即引产，8 名（2.8%）入院立即剖宫产。期待管理两组孕妇自发临产率无显著差异，初产妇和经产妇间也无显著差异。最终，共有 88 名（34.9%）期待管理的孕妇接受了引产。本研究中期待管理组的绒毛膜羊膜炎和子宫内膜炎发生率与全国平均水平相比无显著差异。新生儿重症监护病房（NICU）入住率和 Apgar 评分<7 分的比例也无差异。PROM 至分娩的平均时间在医院期待管理组（27.3 小时）显著短于家庭期待管理组（33.5 小时）。
对于足月 PROM 低危孕妇，家庭或医院期待管理都是合适的选择。适合选择期待管理的孕妇包括：胎先露为头位、胎心监护良好且羊水清亮的足月单胎孕妇。家庭期待管理的可接受时间范围包括：GBS 培养阴性孕妇可期待 24 小时，GBS 培养阳性孕妇可期待 12 小时。
