Medical Student, Duke University School of Medicine, Durham, NC.
Assistant Professor, Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
Obstet Gynecol Surv. 2022 May;77(5):283-292. doi: 10.1097/OGX.0000000000001024.
For patients who present with prelabor rupture of membrane (PROM) in the late preterm period (34 to 36 6/7 weeks), management remains unclear due to lack of consensus. However, recent guidelines have suggested that shared decision-making may be used and expectant management can be considered up to 37 0/7 weeks.
In this article, we review the contemporary studies comparing the risks and benefits of immediate delivery versus expectant management for patients with late preterm prelabor rupture of membranes (PPROM).
Original research articles, review articles, and guidelines on management of late PPROM.
Three randomized clinical trials and 2 meta-analyses comparing expectant management and immediate delivery outcomes in late PPROM showed no significant difference in neonatal sepsis rates between groups. Expectant management increased the likelihood that pregnancies reached term while decreasing the rate of cesarean delivery. However, data suggest an increased risk of antepartum hemorrhage among patients in the expectant management groups, as well as higher rates of histologic chorioamnionitis.
We recommend that clinicians offer expectant management as an alternative to immediate delivery in the setting of late PPROM through a shared decision-making process that clearly outlines the risks and benefits.
对于在晚期早产（34 至 36 6/7 周）时出现胎膜早破（PROM）的患者，由于缺乏共识，管理仍不清楚。然而，最近的指南建议可以使用共同决策，并且可以考虑期待治疗至 37 0/7 周。
在本文中，我们回顾了比较晚期早产胎膜早破（PPROM）患者立即分娩与期待治疗风险和益处的当代研究。
关于晚期 PPROM 管理的原始研究文章、综述文章和指南。
三项比较期待治疗和立即分娩结局的随机临床试验和两项荟萃分析表明，两组新生儿败血症发生率无显著差异。期待治疗增加了妊娠达到足月的可能性，同时降低了剖宫产率。然而，数据表明期待治疗组患者发生产前出血的风险增加，以及组织学绒毛膜羊膜炎的发生率更高。
我们建议临床医生通过共同决策过程，为晚期 PPROM 患者提供期待治疗作为立即分娩的替代方案，明确列出风险和益处。
