Carroll S G, Blott M, Nicolaides K H
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, United Kingdom.
Obstet Gynecol. 1995 Jul;86(1):18-25. doi: 10.1016/0029-7844(95)00085-6.
To investigate the risk of postnatal death in pregnancies with preterm prelabor amniorrhexis in relation to gestational age at both amniorrhexis and delivery.
In 172 singleton pregnancies with preterm prelabor amniorrhexis resulting in live births, postnatal survival and cause of death were examined in relation to gestational age at both amniorrhexis and delivery. In 108 of the patients, the amniotic fluid index (AFI) and fetal breathing movements were determined, and in 98, the internal thoracic circumference and cardiothoracic ratio were also measured. The value of these indices in the prediction of pulmonary hypoplasia was examined.
There were 30 (17%) deaths, 18 of which were due to pulmonary hypoplasia and 12 to prematurity-related complications. Survival was related to both gestational age at amniorrhexis (50% for amniorrhexis before 20 weeks' gestation and 98% when amniorrhexis occurred after 25 weeks) and gestational age at delivery (57% for those born at 24-28 weeks' gestation and 96% for those born after 32 weeks). Pulmonary hypoplasia was also related to both gestational age at amniorrhexis (causing 92% of deaths in the group with amniorrhexis at less than 20 weeks' gestation but none of those with amniorrhexis after 23 weeks) and gestational age at delivery (causing 50% of deaths in the group delivered at 24-28 weeks' gestation and 87% of deaths in infants delivered after 28 weeks). Fetal breathing movements were present in 33 and 63% of cases with and without pulmonary hypoplasia, respectively. The corresponding values for internal thoracic circumference below the 2.5 percentile were 33 and 9%, respectively. There were no significant differences in the AFI or cardiothoracic ratio between the cases with and without pulmonary hypoplasia. Multivariate analysis demonstrated that the only characteristic that contributed significantly in distinguishing between cases with and without pulmonary hypoplasia was gestational age at amniorrhexis.
In pregnancies with preterm prelabor amniorrhexis, postnatal survival is related to both gestational age at amniorrhexis and gestational age at delivery. Prediction of pulmonary hypoplasia is primarily dependent on gestational age at amniorrhexis.
探讨早产前胎膜破裂妊娠的产后死亡风险与胎膜破裂时及分娩时的孕周之间的关系。
对172例因早产前胎膜破裂导致活产的单胎妊娠进行研究，分析产后存活情况及死亡原因与胎膜破裂时及分娩时孕周的关系。对其中108例患者测定羊水指数（AFI）和胎儿呼吸运动，对98例患者测量胸廓内周径和心胸比，检查这些指标在预测肺发育不全方面的价值。
共有30例（17%）死亡，其中18例死于肺发育不全，12例死于早产相关并发症。存活情况与胎膜破裂时的孕周（妊娠20周前胎膜破裂者存活率为50%，25周后胎膜破裂者存活率为98%）及分娩时的孕周（妊娠24 - 28周出生者存活率为57%，32周后出生者存活率为96%）均有关。肺发育不全也与胎膜破裂时的孕周（妊娠20周前胎膜破裂组92%的死亡由其导致，23周后胎膜破裂组无死亡由其导致）及分娩时的孕周（妊娠24 - 28周分娩组50%的死亡由其导致，28周后分娩的婴儿87%的死亡由其导致）有关。有肺发育不全和无肺发育不全的病例中，胎儿呼吸运动出现率分别为33%和63%。胸廓内周径低于第2.5百分位数的相应值分别为33%和9%。有无肺发育不全的病例在AFI或心胸比方面无显著差异。多因素分析表明，区分有无肺发育不全的唯一显著因素是胎膜破裂时的孕周。
在早产前胎膜破裂的妊娠中，产后存活与胎膜破裂时的孕周及分娩时的孕周均有关。肺发育不全的预测主要取决于胎膜破裂时的孕周。
