Berkowitz R L, Hoder E L, Freedman R M, Scott D T, Maltzer M C
Obstet Gynecol. 1982 Sep;60(3):271-6.
The results of a management protocol for women with premature rupture of the membranes (PROM) between 27 and 36 weeks' gestation is presented. Prior to 33 weeks' gestation patients were hospitalized and observed for signs of infection; labor was induced if amnionitis was diagnosed. After 33 weeks patients with vertex presentations underwent elective induction of labor after 16 hours of PROM. Amniocentesis was not performed, corticosteroids were not administered, and tocolysis was not used. The overall perinatal mortality rate was 2.8%. There was only 1 death in the group of 44 patients between 33 and 36 weeks' gestation with PROM for more than 16 hours. This neonate had moderate respiratory distress syndrome and a severe intracranial hemorrhage. The cesarean section rate in the group that underwent labor induction after 16 hours of PROM was 22.7% but only 1 of the 10 operations performed might possibly have been avoided if induction had not been a part of the protocol. In the group of 41 patients managed expectantly but delivered after 16 hours of PROM prior to 33 weeks' gestation, 21.9% were clinically believed to have amnionitis but only 12 neonate had documented sepsis. The implications of these results are discussed.
本文介绍了一项针对妊娠27至36周胎膜早破（PROM）女性的管理方案的结果。妊娠33周前，患者住院并观察感染迹象；若诊断为羊膜炎，则引产。33周后，头先露的患者在胎膜早破16小时后进行选择性引产。未进行羊膜腔穿刺，未使用皮质类固醇，也未使用宫缩抑制剂。围产期总死亡率为2.8%。在44例妊娠33至36周、胎膜早破超过16小时的患者中，仅有1例死亡。该新生儿患有中度呼吸窘迫综合征和严重颅内出血。胎膜早破16小时后引产组的剖宫产率为22.7%，但如果引产不是该方案的一部分，10例手术中可能只有1例可以避免。在41例妊娠33周前胎膜早破16小时后进行期待治疗但分娩的患者中，21.9%临床上被认为患有羊膜炎，但只有12例新生儿有败血症记录。文中讨论了这些结果的意义。
