Department of Obstetrics, Lille University Hospital, Lille, France.
Department of Biostatistics, Lille University Hospital, Lille, France.
Acta Obstet Gynecol Scand. 2022 Jan;101(1):119-126. doi: 10.1111/aogs.14287. Epub 2021 Nov 7.
Preterm prelabor rupture of membranes (PPROM) occurs in 3% of pregnancies and is the main cause (~30%) of premature delivery. Home care seems to be a safe alternative for the management of patients with PPROM, who have a longer latency than those with PPROM managed with conventional hospitalization. We aimed to identify the risk factors associated with a shortened latency before delivery in women with PPROM managed as outpatients.
The design was a retrospective cohort study and the setting was a Monocentric Tertiary centre (Lille University Hospital, France) from 2009 to 2018. All consecutive patients in home care after PPROM at 24-36 weeks were included. For the main outcome measure we calculated the latency ratio for each patient as the ratio of the real latency period to the expected latency period, expressed as a percentage. The risk factors influencing this latency ratio were evaluated.
A total of 234 patients were managed at home after PPROM. Mean latency was 35.5 ± 20.7 days, corresponding to an 80% latency ratio. In 196 (83.8%) patients the length of home care was more than 7 days. A lower latency ratio was significantly associated with oligohydramnios (p < 0.001), gestational age at PPROM (p = 0.006), leukocyte count at PPROM more than 12 × 10 /L (p = 0.025), and C-reactive protein concentration more than 5 mg/L at 7 days after PPROM (p = 0.046). Cervical length was not associated with a lower latency ratio.
Women with PPROM managed with home care are stable. The main risk factor associated with a reduced latency is oligohydramnios. Outpatients with oligohydramnios should be informed of the probability of a shortened latency period.
早产胎膜早破（PPROM）在 3%的妊娠中发生，是早产的主要原因（~30%）。对于 PPROM 患者，家庭护理似乎是一种安全的替代管理方法，与接受传统住院治疗的患者相比，这些患者的潜伏期更长。我们旨在确定与接受门诊管理的 PPROM 患者分娩潜伏期缩短相关的危险因素。
该设计为回顾性队列研究，研究地点为法国里尔大学医院的单中心三级中心（Lille University Hospital，法国），时间范围为 2009 年至 2018 年。所有在 24-36 周发生 PPROM 后接受家庭护理的连续患者均纳入研究。主要结局测量指标是为每位患者计算潜伏期比，即实际潜伏期与预期潜伏期的比值，以百分比表示。评估了影响这种潜伏期比的危险因素。
共有 234 名患者在发生 PPROM 后接受家庭护理。平均潜伏期为 35.5±20.7 天，对应 80%的潜伏期比。在 196 名（83.8%）患者中，家庭护理的时间超过 7 天。潜伏期比值较低与羊水过少（p<0.001）、PPROM 时的胎龄（p=0.006）、PPROM 时白细胞计数超过 12×10/L（p=0.025）以及 PPROM 后 7 天 C-反应蛋白浓度超过 5mg/L（p=0.046）显著相关。宫颈长度与较低的潜伏期比值无关。
接受家庭护理的 PPROM 患者稳定。与潜伏期缩短相关的主要危险因素是羊水过少。应告知羊水过少的门诊患者缩短潜伏期的可能性。
