Jha Shailja, Saxena Purnima, Saluja Sumita, Chellani Harish, Suri Jyotsna, Mukherjee Bijoya, Bachani Sumitra
Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Department of Hematology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Cureus. 2024 Sep 8;16(9):e68917. doi: 10.7759/cureus.68917. eCollection 2024 Sep.
This study aimed to study feto-maternal outcomes in women with preterm prelabor rupture of membranes (PTPROM) on expectant management versus delivery at 34 weeks of gestation and correlate the period of latency and inflammatory markers with delivery outcomes. We have chosen this research topic as there is a paucity of specific guidelines regarding the optimal period of gestation for delivering women with PTPROM.
The study correlated the feto-maternal outcomes in women with PTPROM on expectant management till 37 weeks versus delivery at 34 weeks with a period of latency and maternal inflammatory markers.
This was a prospective observational study conducted on 262 women with PTPROM from 28-33+6 weeks of gestation. Women were monitored till 37 weeks with biweekly total leukocyte count and weekly C-reactive protein, urine routine microscopy, urine culture, high vaginal culture sensitivity, and ultrasound. Women were monitored expectantly till 37 weeks. However, intervention was done at any time during the feto-maternal compromise. There were 52 women who delivered <34 weeks and 210 women who delivered ≥34 weeks. Feto-maternal outcomes were documented. Group A was assigned to women who delivered before 34 weeks and Group B was assigned to women who delivered after 34 weeks. Statistical analysis was done using SPSS software. A p-value <0.05 was considered significant.
Among the study group, 238 (90.8%) women were managed expectantly while 24(9.1%) required intervention. A latency of 3-4 weeks was observed in 131(50%) women. Chorioamnionitis developed in 7 women (4.4%) in group A and 13 women (4.9%) in group B. Neonates developed sepsis in 5.7% in group A and 5.8 % in group B and were comparable in both the groups (p=1.000). Early neonatal death (END) occurred in 10 (3.8%) among which seven died because of low birth weight (LBW), two due to sepsis, and one due to respiratory distress. LBW was significantly associated with END (p<0.001) Conclusion: Expectant management beyond 34 weeks with close monitoring can improve neonatal outcomes without increasing maternal morbidity in women with PTPROM.
本研究旨在探讨胎膜早破（PTPROM）孕妇期待治疗与孕34周分娩的母婴结局，并将潜伏期和炎症标志物与分娩结局相关联。我们选择这个研究主题是因为关于PTPROM孕妇最佳分娩孕周缺乏具体指南。
本研究将PTPROM孕妇期待治疗至37周与孕34周分娩的母婴结局与潜伏期及母体炎症标志物相关联。
这是一项对262例孕28 - 33⁺⁶周的PTPROM孕妇进行的前瞻性观察研究。对孕妇进行监测至37周，每两周进行一次全血细胞计数，每周进行C反应蛋白、尿常规显微镜检查、尿培养、高倍阴道培养敏感性及超声检查。对孕妇进行期待治疗直至37周。然而，在母婴出现并发症的任何时候都进行干预。有52例孕妇在<34周分娩，210例孕妇在≥34周分娩。记录母婴结局。A组分配给在34周前分娩的孕妇，B组分配给在34周后分娩的孕妇。使用SPSS软件进行统计分析。p值<0.05被认为具有统计学意义。
在研究组中，238例（90.8%）孕妇接受了期待治疗，而24例（9.1%）需要干预。131例（50%）孕妇观察到3 - 4周的潜伏期。A组7例（4.4%）孕妇发生绒毛膜羊膜炎，B组13例（4.9%）孕妇发生绒毛膜羊膜炎。A组新生儿败血症发生率为5.7%，B组为5.8%，两组相当（p = 1.000）。早期新生儿死亡（END）发生10例（3.8%），其中7例因低出生体重（LBW）死亡，2例因败血症死亡，1例因呼吸窘迫死亡。低出生体重与早期新生儿死亡显著相关（p<0.001）结论：对于PTPROM孕妇，34周后密切监测下的期待治疗可改善新生儿结局，且不增加母体发病率。
