Bohilțea Roxana Elena, Cioca Ana Maria, Dima Vlad, Ducu Ioniță, Grigoriu Corina, Varlas Valentin, Furtunescu Florentina
Department of Obstetrics, Gynecology and Neonatology, Filantropia Clinical Hospital, 11-13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania.
Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
J Clin Med. 2021 Dec 31;11(1):214. doi: 10.3390/jcm11010214.
Prelabor preterm rupture of the membranes (PPROM) refers to the rupture of the membranes before 37 weeks, but also before the onset of labor. Approximately 3% of pregnancies are complicated by PPROM, which is an important cause of neonatal morbidity and mortality. The aim of the study is to demonstrate the benefit of expectant management in PPROM, compared to immediate birth, defined in our study as birth in the first 48 h. We analyzed 562 pregnancies with PPROM by gestational age groups and short-term morbidities.
We conducted a retrospective observational analytical study, which included women with PPROM between 24 + 0 and 36 + 6 weeks. We divided the cohort into gestational age groups: group 1 gestational age (GA) between 24 and 27, group 2 GA between 28 and 31, group 3 GA between 32 and 34, group 4 GA > 35 weeks. In each group, we analyzed the benefit of the latency period (established in our study as delivery after 48 h of hospitalization) in terms of short-term neonatal complications.
The latency period brought a significant benefit starting with GA greater than 28 weeks; therefore, in the group with GA between 28-31, the complications were significantly statistically lower, mentioning respiratory distress syndrome (no latency 100% vs. latency 85.1%) and admission to the neonatal intensive care unit (no latency 89.7% vs. latency 70.2%). In group 3, with GA between 32-34, we reached statistical significance in terms of respiratory distress syndrome (no latency 61.8% vs. latency 39%), hypoxia (no latency 50% vs. latency 31.7%) and admission to the neonatal intensive care unit (no latency 70.2% vs. latency 47.4%).
Expectant management of pregnancies with PPROM can bring a real benefit in terms of the incidence of complications in premature infants, but this benefit depends most on the gestational age at which the membranes ruptured and the medical conduct put into practice during the latency period.
临产前胎膜早破（PPROM）是指在孕37周前、临产前胎膜破裂。约3%的妊娠合并PPROM，这是新生儿发病和死亡的重要原因。本研究的目的是证明与即刻分娩相比，PPROM期待治疗的益处，在我们的研究中即刻分娩定义为在48小时内分娩。我们按孕周分组并分析了562例PPROM妊娠及短期发病率。
我们进行了一项回顾性观察分析研究，纳入孕24 + 0至36 + 6周的PPROM孕妇。我们将队列分为孕周组：第1组孕周（GA）为24至27周，第2组GA为28至31周，第3组GA为32至34周，第4组GA>35周。在每组中，我们分析了潜伏期（在我们的研究中定义为住院48小时后分娩）在短期新生儿并发症方面的益处。
从GA大于28周开始，潜伏期带来显著益处；因此，在GA为28 - 31周的组中，并发症在统计学上显著更低，提及呼吸窘迫综合征（无潜伏期为100% vs. 潜伏期为85.1%）和入住新生儿重症监护病房（无潜伏期为89.7% vs. 潜伏期为70.2%）。在GA为32 - 34周的第3组中，在呼吸窘迫综合征（无潜伏期为61.8% vs. 潜伏期为39%）、缺氧（无潜伏期为50% vs. 潜伏期为31.7%）和入住新生儿重症监护病房（无潜伏期为70.2% vs. 潜伏期为47.4%）方面达到统计学显著性。
PPROM妊娠的期待治疗在早产儿并发症发生率方面可带来实际益处，但这种益处很大程度上取决于胎膜破裂时的孕周以及潜伏期内实施的医疗行为。
