Goodfellow Laura, Care Angharad, Curran Ciara, Roberts Devender, Turner Mark A, Knight Marian, Zarko Alfirevic
Women's and Children's Health, University of Liverpool, Liverpool, UK.
Little Heartbeats Patient Support Group, Buxton, UK.
BMJ Med. 2024 Mar 19;3(1):e000729. doi: 10.1136/bmjmed-2023-000729. eCollection 2024.
To describe perinatal and maternal outcomes of preterm prelabour rupture of membranes (PPROM) before 23 weeks' gestation in a national cohort.
Prospective observational study.
National population based cohort study with the UK Obstetric Surveillance System (UKOSS), a research infrastructure of all 194 obstetric units in the UK, 1 September 2019 to 28 February 2021.
326 women with singleton and 38 with multiple pregnancies with PPROM between 16+0 and 22+6 weeks+days' gestation.
Perinatal outcomes of live birth, survival to discharge from hospital, and severe morbidity, defined as intraventricular haemorrhage grade 3 or 4, or requiring supplemental oxygen at 36 weeks' postmenstrual age, or both. Maternal outcomes were surgery for removal of the placenta, sepsis, admission to an intensive treatment unit, and death. Clinical data included rates of termination of pregnancy for medical reasons.
Perinatal outcomes were calculated with all terminations of pregnancy for medical reasons excluded, and a worst-best range was calculated assuming that all terminations for medical reasons and those with missing data would have died (minimum value) or all would be liveborn (maximum value). For singleton pregnancies, the live birth rate was 44% (98/223), range 30-62% (98/326-201/326), perinatal survival to discharge from hospital was 26% (54/207), range 17-53% (54/326-173/326), and 18% (38/207), range 12-48% (38/326-157/326) of babies survived without severe morbidity. The rate of maternal sepsis was 12% (39/326) in singleton and 29% (11/38) in multiple pregnancies (P=0.004). Surgery for removal of the placenta was needed in 20% (65/326) and 16% (6/38) of singleton and twin pregnancies, respectively. Five women became severely unwell with sepsis; two died and another three required care in the intensive treatment unit.
In this study, 26% of women who had very early PPROM with expectant management had babies that survived to discharge from hospital. Morbidity and mortality rates were high for both mothers and neonates. Maternal sepsis is a considerable risk that needs more research. These data should be used in counselling families with PPROM before 23 weeks' gestation, and currently available guidelines should be updated accordingly.
描述全国队列中妊娠23周前胎膜早破（PPROM）的围产期及母亲结局。
前瞻性观察性研究。
基于全国人群的队列研究，采用英国产科监测系统（UKOSS），这是一个涵盖英国所有194个产科单位的研究基础设施，研究时间为2019年9月1日至2021年2月28日。
326名单胎妊娠和38名多胎妊娠的妇女，妊娠16⁺⁰至22⁺⁶周⁺天发生PPROM。
活产、出院时存活及严重发病的围产期结局，严重发病定义为3级或4级脑室内出血，或在月经龄36周时需要补充氧气，或两者兼有。母亲结局包括胎盘切除术、败血症、入住重症监护病房及死亡。临床数据包括因医学原因终止妊娠的比率。
排除所有因医学原因终止妊娠后计算围产期结局，并假设所有因医学原因终止妊娠及数据缺失者均死亡（最小值）或均存活（最大值）计算最差 - 最佳范围。单胎妊娠中，活产率为44%（98/223），范围为30 - 62%（98/326 - 201/326），出院时围产期存活率为26%（54/207），范围为17 - 53%（54/326 - 173/326），18%（38/207）的婴儿存活且无严重发病，范围为12 - 48%（38/326 - 157/326）。单胎妊娠母亲败血症发生率为12%（39/326），多胎妊娠为29%（11/38）（P = 0.004）。单胎和双胎妊娠分别有20%（65/326）和16%（6/38）需要进行胎盘切除术。5名妇女因败血症病情严重；2人死亡，另外3人需要在重症监护病房接受治疗。
在本研究中，采用期待治疗的极早早产PPROM妇女中，26%的婴儿存活至出院。母亲和新生儿的发病率及死亡率均很高。母亲败血症是一个重大风险，需要更多研究。这些数据应用于为妊娠23周前发生PPROM的家庭提供咨询，现有指南应据此更新。
