Pylypjuk Christy, Majeau Ladonna
Department of Obstetrics, Gynecology & Reproductive Sciences and Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Obstetrics, Gynecology & Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Int J Womens Health. 2021 Jun 28;13:627-637. doi: 10.2147/IJWH.S303120. eCollection 2021.
To determine perinatal outcomes and influence of amniotic fluid volume in pregnancies complicated by previable, preterm prelabor rupture of membranes (pPPROM).
This was a historical cohort study from two tertiary-level maternity hospitals (January 1, 2009 to December 31, 2015). All pregnancies complicated by pPPROM were identified using ICD coding of discharge abstracts. Hospital charts were reviewed to collect maternal demographics, pregnancy and delivery events, and immediate postnatal outcomes (including survival). Post-processing review of stored ultrasound images was performed to evaluate the relationship between amniotic fluid volume and outcomes.
A total of 113 pregnancies were eligible and 99 were included in the final analysis (74 with "expectant management" and 25 opting for elective termination). The median gestational age at pPPROM was 20+6 weeks [IQR 19+4 to 21+5]. For those choosing expectant management, the median latency between pPPROM and delivery was 7 days, median gestational at delivery was 23+1 weeks, and neonatal survival to discharge was 27.5% overall. There was a trend towards higher rates of pregnancy termination at one hospital (31.7%) compared to the other (15.4%), but no difference between sites with respect to latency, mode of delivery, or survival amongst those managed expectantly. There was a relationship between survival and gestational age at pPPROM (<0.04), as well as initial amniotic fluid volume category: 52.6% of survivors had normal initial amniotic fluid volumes whereas the majority of previable losses had oligohydramnios and the majority of stillbirths had anhydramnios.
After expectant management, more than one in four newborns following pPPROM survived to hospital discharge. While gestational age at rupture was most strongly correlated with survival, normal initial amniotic fluid volumes were mostly seen in survivors whereas stillbirths more frequently had anhydramnios. These findings will help to improve counseling and care of patients with pPPROM and in guiding long-term follow-up studies.
确定妊娠合并未足月产前胎膜早破（pPPROM）时的围产期结局及羊水过少的影响。
这是一项来自两家三级妇产医院（2009年1月1日至2015年12月31日）的历史性队列研究。通过出院摘要的ICD编码识别所有合并pPPROM的妊娠。查阅医院病历以收集产妇人口统计学资料、妊娠和分娩事件以及产后即时结局（包括存活情况）。对存储的超声图像进行后期处理回顾，以评估羊水量与结局之间的关系。
共有113例妊娠符合条件，99例纳入最终分析（74例采用“期待治疗”，25例选择选择性终止妊娠）。pPPROM时的中位孕周为20⁺⁶周[四分位间距为19⁺⁴至21⁺⁵周]。对于选择期待治疗的患者，pPPROM与分娩之间的中位间隔时间为7天，分娩时的中位孕周为23⁺¹周，总体新生儿存活至出院的比例为27.5%。与另一家医院（15.4%）相比，一家医院的妊娠终止率有升高趋势（31.7%），但在期待治疗患者的间隔时间、分娩方式或存活情况方面，两家医院之间没有差异。存活情况与pPPROM时的孕周（<0.04）以及初始羊水量类别有关：52.6%的存活者初始羊水量正常，而大多数未足月死亡者羊水过少，大多数死产者羊水过少。
期待治疗后，pPPROM后超过四分之一的新生儿存活至出院。虽然胎膜破裂时的孕周与存活最密切相关，但存活者大多初始羊水量正常，而死产者更常见羊水过少。这些发现将有助于改善pPPROM患者的咨询和护理，并指导长期随访研究。
