胎膜早破早产孕妇48小时及以上分娩的预测因素：一项回顾性队列研究。
Predictors of delivery at 48 hours or more in pregnant women with preterm prelabor rupture of membrane: A retrospective cohort study.
作者信息
Duangkum Chatuporn, Pattamathamakul Suphawan, Chaiyarach Sukanya, Saksiriwuttho Piyamas, Sothornwit Jen, Paopongsawan Pongsatorn, Sawanyawisuth Kittisak, Chantanaviliai Sathida, Pongsamakthai Manasicha
机构信息
Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
出版信息
Eur J Obstet Gynecol Reprod Biol X. 2025 May 1;26:100393. doi: 10.1016/j.eurox.2025.100393. eCollection 2025 Jun.
OBJECTIVE
Expectant management is an option for preterm prelabor rupture of the membrane (PPROM) between 34 0/7 and 36 6/7 weeks of gestation. Even though expectant delivery in PPROM is justified, there is limited data on predictors of PPROM delivered > 48 hrs in a real-world setting. Therefore, this study aimed to find clinical predictors for delivery > 48 hrs in women with PPROM as well as clinical outcomes in clinical practice.
MATERIALS AND METHODS
This was a retrospective cohort study conducted at two tertiary care hospitals. The inclusion criteria were a singleton pregnancy with PPROM and planned expectant management. Clinical data were retrieved from the hospitals' databases. Eligible pregnant women were categorized into two groups: PPROM delivered < 48 hrs or PPROM delivered > 48 hrs. The primary outcome was factors predictive of PPROM delivered > 48 hrs.
RESULTS
During the study period, 519 pregnant women met the study criteria. Of those, 90 pregnant women (17.34 %) had PPROM delivered > 48 hrs. Factors independently associated with PPROM delivered > 48 hrs were maternal age ≥ 19 years (adjusted odds ratio [aOR] 0.95, 95 % CI [0.91, 0.99]) and oligohydramnios (aOR 2.41, 95 % CI [1.45, 4.00]). Regarding maternal and neonatal outcomes, the PPROM delivered > 48 hrs group had lower neonatal birth weights (2245 g vs. 2490 g; p < 0.001) than the PPROM delivered < 48 hrs group. However, neonatal outcomes, including respiratory distress, sepsis, neonatal intensive care unit admission, early jaundice, hypoglycemia, positive pressure ventilation, and early respiratory support, were not different.
CONCLUSIONS
Clinical predictors for PPROM delivered > 48 hrs in a real-world setting were maternal age and presence of oligohydramnios. Maternal and neonatal outcomes in the PPROM delivered > 48 hrs were almost comparable with the PPROM delivered < 48 hrs. PPROM delivered > 48 hrs may be safe and can be a treatment option for PPROM. However, further studies may be required in terms of generalizability as this study was conducted retrospectively in tertiary care hospitals in Thailand.
目的
对于妊娠34⁰/₇至36⁶/₇周的胎膜早破（PPROM）患者，期待治疗是一种选择。尽管PPROM患者进行期待分娩是合理的，但在现实环境中，关于PPROM患者分娩超过48小时的预测因素的数据有限。因此，本研究旨在寻找PPROM患者分娩超过48小时的临床预测因素以及临床实践中的临床结局。
材料与方法
这是一项在两家三级医疗医院进行的回顾性队列研究。纳入标准为单胎妊娠合并PPROM且计划进行期待治疗。临床数据从医院数据库中检索。符合条件的孕妇分为两组：PPROM分娩时间<48小时或PPROM分娩时间>48小时。主要结局是预测PPROM分娩时间>48小时的因素。
结果
在研究期间，519名孕妇符合研究标准。其中，90名孕妇（17.34%）PPROM分娩时间>48小时。与PPROM分娩时间>48小时独立相关的因素为产妇年龄≥19岁（调整优势比[aOR]0.95，95%置信区间[CI][0.91,0.99]）和羊水过少（aOR 2.41，95%CI[1.45,4.00]）。关于母婴结局，PPROM分娩时间>48小时组的新生儿出生体重低于PPROM分娩时间<48小时组（2245g对2490g；p<0.001）。然而，包括呼吸窘迫、败血症、新生儿重症监护病房入院、早期黄疸、低血糖、正压通气和早期呼吸支持在内 的新生儿结局并无差异。
结论
在现实环境中，PPROM分娩时间>48小时的临床预测因素为产妇年龄和羊水过少。PPROM分娩时间>48小时的母婴结局与PPROM分娩时间<48小时的情况几乎相当。PPROM分娩时间>48小时可能是安全的，可作为PPROM的一种治疗选择。然而，由于本研究是在泰国的三级医疗医院进行的回顾性研究，在普遍性方面可能需要进一步研究。
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