Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy.
Department of Health Science, University of Florence, Maternal Infant Department Careggi Hospital, Florence, Italy.
Eur J Obstet Gynecol Reprod Biol. 2021 Jun;261:1-6. doi: 10.1016/j.ejogrb.2021.03.036. Epub 2021 Apr 1.
Expectant management in patients with prelabor preterm rupture of membranes between between 34 and 36 weeks (late preterm pPROM or LpPROM) has been shown to decrease the burden of prematurity, when compared to immediate delivery. As the severity of prematurity depends on gestational age (GA) at PROM, and PROM to delivery interval, we first investigated how such variables affect neonatal outcomes (NO). Second, we assessed the risk of neonatal sepsis.
retrospective cohort study on neonatal morbidity among singleton infants born to expectantly managed mothers with LpPROM in five hospitals affiliated with three Italian academic institutions. The primary NO was a composite of neonatal death, non-invasive (cPAP) or invasive (mechanical ventilation) respiratory support, hypoglycemia (< 44 mg/dl needing therapy), newborn sepsis, confirmed seizures, stroke, intraventricular hemorrhage (IVH), basal nuclei anomalies, cardiopulmonary resuscitation, umbilical-cord-blood arterial pH < 7.0 or base excess < -12.5, and prolonged hospitalization (≥ 5 days). Univariate analysis described differences in the population according to GA at delivery. Multivariate logistic regression was then used to investigate the effects of GA at PROM, and PROM to delivery interval on the NO.
258/606 (42.6 %) women with LpPROM were expectantly managed, as they did not deliver within the first 24 h. The median latency duration was 2 (95 %CI 1-3) days, having no effect on neonatal morbidity on multivariate analysis. Multivariate analysis also showed increased risks of adverse NO among PROM at 34 (OR 2.3 95 %CI 1.03-5.1) but not at 35 weeks when compared to 36 weeks, and among women receiving antenatal corticosteroids (OR 3.6 95 %CI 1.3-9.7), while antibiotic treatment showed a non-significant protective effect (OR 0.2 95 %CI 0.04-1.02). Prevalence of neonatal sepsis was 0.8 % (2/258) CONCLUSION: Expectant management of LpPROM should be encouraged especially between 34 and 34 weeks', when the burden of prematurity is the greatest. Antibiotics may have beneficial effects, while careful consideration should be given to antenatal corticosteroids until future studies specifically address LpPROM.
与立即分娩相比，在 34 至 36 周（晚期早产胎膜早破或 LpPROM）之间的临产胎膜早破患者中进行期待治疗已被证明可以降低早产的负担。由于早产的严重程度取决于胎膜早破时的孕龄（GA）和胎膜早破至分娩的时间间隔，因此我们首先研究了这些变量如何影响新生儿结局（NO）。其次，我们评估了新生儿败血症的风险。
对意大利三所学术机构附属的五家医院中接受期待治疗的 LpPROM 单胎婴儿的新生儿发病率进行回顾性队列研究。主要新生儿结局（NO）是复合的，包括新生儿死亡、无创（CPAP）或有创（机械通气）呼吸支持、低血糖（<44mg/dl 需要治疗）、新生儿败血症、确诊癫痫发作、中风、脑室内出血（IVH）、基底核异常、心肺复苏、脐动脉血 pH 值<7.0 或碱缺失<-12.5，以及住院时间延长（≥5 天）。单变量分析根据分娩时的 GA 描述了人群中的差异。然后，使用多变量逻辑回归来研究 PROM 时的 GA 和 PROM 至分娩的时间间隔对 NO 的影响。
606 例 LpPROM 孕妇中有 258 例（42.6%）接受期待治疗，因为她们在 24 小时内未分娩。中位潜伏期持续时间为 2 天（95%CI 1-3），但在多变量分析中对新生儿发病率无影响。多变量分析还显示，与 36 周相比，PROM 发生在 34 周时（OR 2.3，95%CI 1.03-5.1）和接受产前皮质类固醇治疗时（OR 3.6，95%CI 1.3-9.7）的不良 NO 风险增加，而抗生素治疗显示出非显著的保护作用（OR 0.2，95%CI 0.04-1.02）。新生儿败血症的患病率为 0.8%（2/258）。
应鼓励对 LpPROM 进行期待治疗，尤其是在 34 至 34 周之间，此时早产的负担最大。抗生素可能有有益的作用，而在产前皮质类固醇的使用应谨慎考虑，直到未来的研究专门针对 LpPROM 进行研究。
