BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecología, Obstetrícia I Neonatología, Fetal i+D Fetal Medicine Research Center, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Int J Gynaecol Obstet. 2023 Aug;162(2):703-710. doi: 10.1002/ijgo.14726. Epub 2023 Mar 3.
To evaluate the maternal, fetal, and neonatal outcomes of pregnant women complicated with preterm prelabor rupture of membranes (PPROM) eligible for outpatient care.
This study included a retrospective cohort of patients with singleton pregnancies with PPROM between 23 to 34 weeks who remained pregnant after the first 72 h. Outpatient management was considered in women with clinical, ultrasound and analytical stability, and easy access to hospital. Maternal, fetal, and neonatal results were compared between women managed as inpatients versus those managed as outpatients.
Women eligible for the outpatient management had a better prognostic profile (no anhydramnios, longer cervical length, less intraamniotic infection, and clinical, ultrasound, and analytical stability) and presented a lower gestational age at admission and longer latency to delivery, resulting in a similar gestational age at delivery as the inpatient group. Postpartum curettage, uterine atony, respiratory distress syndrome, and bronchopulmonary dysplasia were less frequent in the outpatient group. Composite maternal-fetal morbidity and mortality outcomes were similar in both groups, while composite neonatal morbidity and mortality outcomes were significantly lower in the outpatient group.
Outpatient management may be an option for women presenting stable PPROM before 34 weeks when adequate selection criteria are fulfilled. Differences in perinatal outcomes in the outpatient group compared with the inpatient group are probably attributable to baseline characteristics. Further prospective randomized studies are needed to confirm the benefits of outpatient management in PPROM.
评估适合门诊治疗的胎膜早破（PPROM）孕妇的母婴和新生儿结局。
本研究纳入了 23 至 34 周单胎妊娠且在首次 72 小时后仍处于妊娠状态的患者，这些患者均有 PPROM。对临床、超声和分析稳定且易于就诊医院的患者考虑门诊管理。比较了住院管理和门诊管理的孕妇的母婴和新生儿结局。
适合门诊管理的孕妇具有更好的预后特征（无羊水过少、更长的宫颈长度、更少的宫内感染、临床、超声和分析稳定），入院时的胎龄较低，分娩潜伏期较长，导致与住院组的分娩时胎龄相似。门诊组产后刮宫术、子宫收缩乏力、呼吸窘迫综合征和支气管肺发育不良的发生率较低。复合母婴发病率和死亡率在两组之间相似，而门诊组复合新生儿发病率和死亡率明显较低。
当满足充分的选择标准时，门诊管理可能是稳定的 34 周前出现胎膜早破孕妇的一种选择。与住院组相比，门诊组围产期结局的差异可能归因于基线特征。需要进一步的前瞻性随机研究来证实门诊管理在胎膜早破中的益处。
