Graham R L, Gilstrap L C, Hauth J C, Kodack-Garza S, Conaster D G
Obstet Gynecol. 1982 May;59(5):607-10.
The management of pregnant patients with premature rupture of membranes (PROM) prior to 32 weeks' gestation or at 32 to 34 weeks' gestation is controversial. In a retrospective analysis of 109 patients with PROM at or prior to 34 weeks' gestation, 53 (49%) were managed conservatively, and labor was eigher induced or occurred spontaneously within 24 hours in 56 (51%). Patients initially presenting with chorioamnionitis were excluded from this study, as were all patients with evidence of a fetal anomaly or a medical indication for delivery. The 53 patients managed conservatively had a mean pregnancy prolongation of 21 days (range, 2 to 105 days median, 7 days). The infants of patients managed conservatively had a lower incidence of respiratory distress syndrome (P less than .0025), mortality (P less than .05), and intracranial hemorrhage (P less than .03). Sixty-four percent of the conservatively managed group versus 45% of the induced/spontaneous labor group were found to be normal upon physical and neurologic examination when discharged from the hospital (P less than .035). The difference in incidence of neonatal sepsis between these 2 groups was not statistically significant (P = .42). Immediate induction of labor and/or delivery for patients with PROM at less than 32 weeks' gestation resulted in a significant increase in perinatal mortality and morbidity.
妊娠32周前或32至34周胎膜早破（PROM）孕妇的管理存在争议。在一项对109例妊娠34周及以前发生胎膜早破患者的回顾性分析中，53例（49%）采取保守治疗，56例（51%）在24小时内引产或自然分娩。本研究排除了最初表现为绒毛膜羊膜炎的患者，以及所有有胎儿异常证据或有分娩医学指征的患者。采取保守治疗的53例患者平均妊娠延长21天（范围2至105天，中位数7天）。采取保守治疗患者的婴儿呼吸窘迫综合征发生率较低（P<0.0025），死亡率较低（P<0.05），颅内出血发生率较低（P<0.03）。出院时体格检查和神经学检查发现，保守治疗组64%的婴儿正常，而引产/自然分娩组为45%（P<0.035）。这两组新生儿败血症发生率的差异无统计学意义（P=0.42）。妊娠32周前胎膜早破患者立即引产和/或分娩会导致围产期死亡率和发病率显著增加。
