Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Taiwan J Obstet Gynecol. 2023 Jul;62(4):543-546. doi: 10.1016/j.tjog.2022.09.016.
Preterm prelabor rupture of fetal membranes (pPROM) is a leading cause of preterm birth. When pPROM occurs around the pre- and periviable period, the perinatal outcome is unfavorable. However, there have been a few cases in which the leakage of amniotic fluid ceases and the ruptured fetal membranes are spontaneously sealed.
The prognosis of 38 cases of pPROM at less than 27 weeks of gestation in Kyoto University Hospital were studied. The clinical factors related to the sealing of fetal membranes were investigated.
Spontaneous sealing was confirmed in five patients (13%), and sealing occurred within 14 days of pPROM. Women in the no sealing group delivered at 26.3 ± 0.5 weeks of gestation, whereas women in the sealing group delivered at term at 38.8 ± 0.4 weeks (p < 0.0001). The maximum vertical pocket (MVP) of amniotic fluid at the time of pPROM diagnosis was 2.2 ± 0.3 cm in the no sealing group and 3.8 ± 0.5 cm in the sealing group (p = 0.043). All cases of sealing occurred when the MVP at diagnosis was more than 2 cm, and there were no cases of sealing if the MVP at diagnosis was less than 2 cm. In addition, the value of C-reactive protein at ROM was less than 0.4 mg/dL in all cases in the sealing group.
The residual volume of sterile amniotic fluid at the onset of pPROM may predict the possibility of fetal membrane sealing.
胎膜早破（PPROM）是早产的主要原因。当 PPROM 发生在早产前期和围生期时，围产儿结局不佳。然而，有少数情况下羊水渗漏停止，破裂的胎膜会自行封闭。
研究了京都大学医院 38 例妊娠 27 周前胎膜早破的病例，调查了与胎膜封闭相关的临床因素。
5 例（13%）患者证实自发封闭，封闭发生在胎膜早破后 14 天内。未封闭组的孕妇在 26.3±0.5 周分娩，而封闭组在 38.8±0.4 周足月分娩（p<0.0001）。胎膜早破诊断时羊水最大垂直深度（MVP）在未封闭组为 2.2±0.3cm，在封闭组为 3.8±0.5cm（p=0.043）。所有封闭病例的 MVP 在诊断时均大于 2cm，而 MVP 在诊断时小于 2cm 时则无封闭病例。此外，在封闭组中，ROM 时 C 反应蛋白值均小于 0.4mg/dL。
胎膜早破时无菌羊水的残留量可能预测胎膜封闭的可能性。
