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胎膜早破的评估与管理:一篇综述文章

Evaluation and Management of Premature Rupture of Membranes: A Review Article.

作者信息

Garg Aditi, Jaiswal Arpita

机构信息

Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND.

出版信息

Cureus. 2023 Mar 24;15(3):e36615. doi: 10.7759/cureus.36615. eCollection 2023 Mar.

Abstract

Premature rupture of membranes (PROM), now also referred to as "pre-labour rupture of membranes," is the rupture of gestational membranes after 37 weeks but before the process of labour begins. When membrane rupture occurs before 37 weeks of gestation, it is referred to as preterm PROM (PPROM). Prematurity is held accountable for the majority of newborn morbidity and mortality. PROM causes around one-third of all preterm deliveries and complicates 3% of pregnancies. Significant morbidity and mortality rates have been associated with PROM. Preterm (PROM) pregnancies are more difficult to manage. Pre-labour rupture of membranes is characterised by its short latency, higher intrauterine infection risk, and greater umbilical cord compression probability. Women with preterm PROM are more likely to develop chorioamnionitis and placental abruption. Various diagnostic modalities include sterile speculum examination, the nitrazine test, the ferning test, and the latest advances, which are the Amnisure test and the Actim test. Despite all these tests, there is still a need for newer, non-invasive, rapid, and accurate tests. Admission to a hospital, amniocentesis to rule out infection, and, if necessary, prenatal corticosteroids and broad-spectrum antibiotics are all alternatives for treatment. As a result, the clinician managing a pregnant woman whose pregnancy has been affected by PROM plays a crucial role in the management and must be well aware of probable complications and control measures to reduce risks and increase the likelihood of the required outcome. PROM's proclivity for recurrence in later pregnancies provides a chance for prevention. Furthermore, prenatal and neonatal care developments will continue to enhance the outcomes of women and their children. The purpose of this article is to summarise the concepts related to the evaluation and management of PROM.

摘要

胎膜早破(PROM),现在也被称为“临产前胎膜破裂”,是指妊娠37周后但在分娩过程开始前胎膜破裂。当胎膜在妊娠37周前破裂时,则称为早产胎膜早破(PPROM)。早产是大多数新生儿发病和死亡的原因。胎膜早破导致约三分之一的早产,并使3%的妊娠复杂化。胎膜早破与显著的发病率和死亡率相关。早产(胎膜早破)妊娠更难管理。临产前胎膜破裂的特点是潜伏期短、宫内感染风险高以及脐带受压概率大。早产胎膜早破的女性更易发生绒毛膜羊膜炎和胎盘早剥。各种诊断方法包括无菌窥器检查、石蕊试纸试验、羊齿状结晶试验,以及最新进展,即羊膜检测试验和Actim试验。尽管有所有这些检测方法,但仍需要更新的、非侵入性的、快速且准确的检测方法。住院、羊水穿刺以排除感染,必要时使用产前皮质类固醇和广谱抗生素都是可供选择的治疗方法。因此,管理受胎膜早破影响的孕妇的临床医生在管理中起着至关重要的作用,必须充分了解可能的并发症和控制措施,以降低风险并提高达到预期结果的可能性。胎膜早破在后续妊娠中复发的倾向为预防提供了机会。此外,产前和新生儿护理的发展将继续改善妇女及其子女的结局。本文的目的是总结与胎膜早破评估和管理相关的概念。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8ad/10122752/a2025839c69c/cureus-0015-00000036615-i01.jpg

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