Cate Jennifer J M, Chu Allison, Lambert Katherine, Sugrue Ronan, Wheeler Sarahn, Grace Matthew R, Adams William A, Dotters-Katz Sarah
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
Duke University School of Medicine, Durham, North Carolina.
Am J Perinatol. 2025 Apr;42(6):813-817. doi: 10.1055/a-2405-3609. Epub 2024 Sep 27.
Previable premature prelabor rupture of membranes (pPPROM) can lead to significant maternal and neonatal morbidity and mortality. Limited literature exists describing long-term outcomes in neonates surviving pPPROM. Our study describes 2-year survival and outcomes after expectantly managed pPPROM at a single, tertiary, academic center. This is a retrospective review including individuals with pPPROM defined as membrane rupture before 24 weeks who were candidates and opted for expectant management at a single tertiary academic center between 2013 and 2022. Patients were included if they delivered after 22 weeks. Patients opting for termination, with contraindication to expectant management or who chose expectant management without planned neonatal resuscitation at birth were excluded. Electronic records of patients and associated neonates were reviewed for demographic information, PPROM management, and neonatal outcomes at 2 years including gastrointestinal, respiratory, cognitive, motor, and hearing or vision issues. Descriptive statistical analysis was performed. Of 111 pregnancies with pPPROM, 50(45%) pregnant individuals met inclusion criteria (46 singletons; 4 multiples [3 twins, 1 set of quads]). Of 46 singletons, 31 (67%) survived to 2 years with 1(3%) alive but less than 2 years. In 3/4 (75%) twin gestations, both twins survived to 2 years. A total of 3/4 (75%) quadruplets survived to 2 years. Most surviving infants (95.0%, = 38) had at least one documented adverse outcome. A total of 55.0% ( = 22) of neonates had gross motor delay, and 77.5% ( = 31) had documented speech delay. Most had respiratory issues with reactive airway disease most common (22.5% = 9). Gastrointestinal issues were common with gastrostomy tube in 32.5% ( = 13) and short gut syndrome in 15% ( = 6). Over half of neonates with expectantly managed pPPROM survived with high rates of adverse outcomes with over half with documented gross motor and speech delay present at 2 years. Respiratory and gastrointestinal issues were also common. These data provide information for important patient counseling on long-term outcomes in expectantly managed pPPROM. · Adverse outcomes at 2 years after pPPROM were prevalent.. · Speech delay at 2 years was the most common outcome.. · Motor delay occurred in 55% of neonates at 2 years.. · Long-term pPPROM data can guide counseling..
未达可存活孕周的胎膜早破（pPPROM）可导致严重的母婴发病率和死亡率。关于pPPROM存活新生儿长期预后的文献有限。我们的研究描述了在一家单一的三级学术中心对pPPROM进行期待治疗后的2年生存率和预后情况。这是一项回顾性研究，纳入了2013年至2022年期间在一家单一的三级学术中心被定义为孕24周前胎膜破裂且符合条件并选择期待治疗的pPPROM患者。如果患者在孕22周后分娩则被纳入。选择终止妊娠、有期待治疗禁忌证或选择期待治疗但出生时未计划进行新生儿复苏的患者被排除。查阅患者及其相关新生儿的电子记录，以获取人口统计学信息、pPPROM的治疗情况以及2岁时的新生儿预后，包括胃肠道、呼吸、认知、运动以及听力或视力问题。进行了描述性统计分析。在111例pPPROM妊娠中，50例（45%）孕妇符合纳入标准（46例单胎；4例多胎[3例双胎，1例四胞胎]）。在46例单胎中，31例（67%）存活至2岁，1例（3%）存活但不足2岁。在3/4（75%）的双胎妊娠中，两个胎儿均存活至2岁。共有3/4（75%）的四胞胎存活至2岁。大多数存活婴儿（95.0%，n = 38）至少有一项记录在案的不良预后。共有55.0%（n = 22）的新生儿存在粗大运动发育迟缓，77.5%（n = 31）有记录在案的语言发育迟缓。大多数有呼吸系统问题，其中反应性气道疾病最为常见（22.5%，n = 9）。胃肠道问题也很常见，32.5%（n = 13）的患儿需要胃造瘘管，15%（n = 6）患有短肠综合征。超过半数接受期待治疗的pPPROM新生儿存活，但不良预后发生率较高，超过半数在2岁时有记录在案的粗大运动和语言发育迟缓。呼吸和胃肠道问题也很常见。这些数据为针对pPPROM期待治疗长期预后的重要患者咨询提供了信息。· pPPROM后2年不良预后普遍存在。· 2岁时语言发育迟缓是最常见的预后情况。· 2岁时55%的新生儿出现运动发育迟缓。· pPPROM长期数据可指导咨询。
