Farooqi A, Holmgren P A, Engberg S, Serenius F
Department of Pediatrics, Umea University Hospital, Sweden.
Obstet Gynecol. 1998 Dec;92(6):895-901. doi: 10.1016/s0029-7844(98)00287-7.
To evaluate the perinatal and 2-year outcomes in pregnancies complicated by preterm premature rupture of membranes (PROM) during the second trimester.
Fifty-three consecutive singleton pregnancies with PROM at 14 to 28 weeks of gestation were studied retrospectively. Management goals were to prolong the pregnancies to 32 weeks through expectant management and to avoid fetal compromise through closer monitoring and active intervention, when necessary, after 23 weeks. Outcome of the surviving infants was based on neurologic, audiometric, and ophthalmologic examinations at 2 years of corrected age.
Rupture of membranes occurred at 14-19 weeks (mean 17.4 weeks) in 10 women, at 20-25 weeks (mean 24.0 weeks) in 24, and at 26-28 weeks (mean 27.6 weeks) in 19. The median latency periods to delivery were 72 days, 12 days, and 10 days when rupture of membranes occurred at 14-19 weeks, 20-25 weeks, and 26-28 weeks, respectively. The overall incidence of chorioamnionitis was 28%. There were no fetal deaths and nine neonatal deaths. When rupture of membranes occurred at 14-19 weeks, 20-25 weeks, and 26-28 weeks, the perinatal survival rates were 40%, 92%, and, 100%, respectively. Pulmonary hypoplasia accounted for seven deaths. Of the live-born infants, 81% were alive at 2 years of corrected age. Survival without major impairment was observed in 75%, 80%, and 100% of the survivors when rupture of membranes occurred at 14-19 weeks, 20-25 weeks, and 26-28 weeks, respectively.
Expectant management of second-trimester PROM offers better perinatal and long-term survival than previously thought.
评估妊娠中期合并胎膜早破（PROM）的围产期及2年结局。
回顾性研究53例妊娠14至28周连续单胎妊娠合并PROM的病例。管理目标是通过期待治疗将妊娠延长至32周，并在23周后必要时通过密切监测和积极干预避免胎儿受损。存活婴儿的结局基于矫正年龄2岁时的神经、听力和眼科检查。
10例妇女胎膜破裂发生在14 - 19周（平均17.4周），24例发生在20 - 25周（平均24.0周），19例发生在26 - 28周（平均27.6周）。当胎膜破裂发生在14 - 19周、20 - 25周和26 - 28周时，至分娩的中位潜伏期分别为72天、12天和10天。绒毛膜羊膜炎的总体发生率为28%。无胎儿死亡，9例新生儿死亡。当胎膜破裂发生在14 - 19周、20 - 25周和26 - 28周时，围产儿存活率分别为40%、92%和100%。肺发育不全导致7例死亡。在存活婴儿中，矫正年龄2岁时81%存活。当胎膜破裂发生在14 - 19周、20 - 25周和26 - 28周时，分别有75%、80%和100%的存活者存活且无严重损害。
妊娠中期PROM的期待治疗提供了比先前认为更好的围产期和长期存活率。
