Sherer D M, Spong C Y, Salafia C M
Intramural Division, National Institute of Child Health and Human Development, National Institutes of Health, USA.
Am J Perinatol. 1997 Mar;14(3):125-8. doi: 10.1055/s-2007-994111.
The objective of this study was assess whether residual amniotic fluid volume (AFV) following premature rupture of the membranes (PROM) is associated with fetal presentation, or the prevalence of either clinical or histologic infection in patients delivering below 32 weeks' gestation. From an established database of 465 deliveries below 32 weeks' gestation, patients with singleton, nonanomalous fetuses with AFV assessment within 24 hours of delivery were studied (n = 146). Fetal presentation was confirmed by ultrasound identifying 46 breech and 100 vertex-presenting fetuses. Premature rupture of the membranes was diagnosed by sterile speculum examination. Clinical chorioamnionitis was diagnosed by previously published criteria. Histopathology examination of the extraplacental amnion and the umbilical cord were performed by a single pathologist blinded to clinical data. Outcome variables evaluated: rupture-to-delivery interval, gestational age at delivery, neonatal morbidity parameters (1- and 5-min Apgar scores < 5 and 7, respectively; incidence of respiratory distress syndrome; bronchopulmonary dysplasia; retinopathy of prematurity; neonatal sepsis; intraventricular hemorrhage; days of ventilation; and hospitalization), and placental histologic parameters of maternal and/or fetal acute inflammation. Statistical analysis included contingency tables and analysis of variance with p < .05 considered significant, after corrections for multiple comparisons when appropriate. Residual AF volume following PROM was significantly lower in breech compared with vertex presentation (AFV = 0 in 20 vs. 34; AFV = 1 in 19 vs. 27; AFV = 2 in 7 vs. 39, respectively, p = .014). No significant difference was noted in the rupture-to-delivery interval, gestational age at delivery, neonatal morbidity parameters, or histologic evidence of maternal and/or fetal acute inflammation (50% vs. 42%, p > .2) between gestations with breech or vertex presentations. The incidence of clinical chorioamnionitis was significantly lower in breech compared with vertex presentation (40% vs. 60%, p < .05). We conclude that following PROM below 32 weeks' gestation, in breech-presenting fetuses, the residual AFV and incidence of clinical chorioamnionitis are significantly decreased compared with vertex-presenting fetuses.
本研究的目的是评估胎膜早破（PROM）后羊水残余量（AFV）是否与胎儿先露情况相关，或与妊娠32周前分娩患者的临床或组织学感染发生率相关。从一个已建立的妊娠32周前分娩的465例数据库中，研究了单胎、非畸形胎儿且在分娩后24小时内进行AFV评估的患者（n = 146）。通过超声确认胎儿先露情况，其中46例为臀位，100例为头位。胎膜早破通过无菌窥器检查诊断。临床绒毛膜羊膜炎根据先前公布的标准诊断。胎盘外羊膜和脐带的组织病理学检查由一位对临床数据不知情的病理学家进行。评估的结局变量包括：破膜至分娩间隔、分娩时的孕周、新生儿发病率参数（1分钟和5分钟阿氏评分分别<5分和<7分；呼吸窘迫综合征发病率；支气管肺发育不良；早产儿视网膜病变；新生儿败血症；脑室内出血；通气天数；住院天数）以及母体和/或胎儿急性炎症的胎盘组织学参数。统计分析包括列联表和方差分析，p <.05被认为具有统计学意义，在适当情况下对多重比较进行校正后。与头位相比，臀位胎膜早破后的羊水残余量显著更低（AFV = 0的情况分别为20例对34例；AFV = 1的情况分别为19例对27例；AFV = 2的情况分别为7例对39例，p =.014）。臀位和头位妊娠在破膜至分娩间隔、分娩时的孕周、新生儿发病率参数或母体和/或胎儿急性炎症的组织学证据方面（50%对42%，p >.2）未观察到显著差异。与头位相比，臀位临床绒毛膜羊膜炎的发生率显著更低（40%对60%，p <.05）。我们得出结论，在妊娠32周前胎膜早破后，与头位胎儿相比，臀位胎儿的羊水残余量和临床绒毛膜羊膜炎的发生率显著降低。
