Neonatal outcomes and four-year follow-up after spontaneous or iatrogenic preterm prelabor rupture of membranes before 24 weeks
Neonatal outcomes and four-year follow-up after spontaneous or iatrogenic preterm prelabor rupture of membranes before 24 weeks
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DOI：
10.1080/00016340902971433
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发表时间：
2009-01-01
影响因子：
4.3
通讯作者：
Collet, Frederique
中科院分区：
文献类型：
--
作者：
Chauleur, Celine;Rochigneux, Stephanie;Collet, Frederique
Objective.目的探讨妊娠24周前合并早产胎膜破裂（PPROM）的新生儿结局及4年随访。设计回顾性研究。设置.圣艾蒂安大学医院，三级中心，法国。方法.对1999年至2004年（6年）期间出生的38例妊娠和44例胎儿的产科和新生儿记录进行了研究，这些胎儿在妊娠14周至23 + 6周之间患有PPROM。我们分析了自发性（A组）和医源性PPROM（B组）病例，包括母体、胎儿、胎盘和新生儿特征。存活的婴儿被跟踪到4岁。结果PPROM的中位孕龄为21周[范围15-23 + 6]。在38例PPROM患者中，22例（A）为自发性PPROM，16例（B）在妊娠期间接受了侵入性手术。对25名妇女进行期待治疗：A组12名（13名胎儿），B组13名（16名胎儿）。从PPROM到分娩的中位潜伏期为35天[范围1-163天]。两组差异有统计学意义。总存活率为59%（17个胎儿），A组有3个婴儿在医院死亡。出院存活率为48%（14/29）。在14名存活的婴儿中，71%的婴儿在4岁时具有正常的神经和发育结果。A组仅有2名婴儿存活，无明显后遗症。结论医源性PPROM后妊娠的预后优于自发性PPROM。皮质类固醇和抗生素的强化管理似乎是有帮助的。自发性PPROM的新生儿存活率在24周前仍然很低，在这些情况下讨论终止妊娠似乎是合理的。
Objective. To assess the neonatal outcome and four-year follow-up of pregnancies complicated by preterm prelabor rupture of membranes (PPROM) before 24 weeks. Design. Retrospective study. Setting. University Hospital of Saint Etienne, tertiary level center, France. Methods. Obstetric and neonatal records of 38 pregnancies and 44 fetuses born between 1999 and 2004 (six years) with PPROM between 14 and 23 + 6 weeks of gestation were studied. We analyzed spontaneous (group A) and iatrogenic PPROM (Group B) cases, including maternal, fetal, placental, and neonatal characteristics. Surviving infants were followed until the age of four. Results. Median gestational age at PPROM was 21 weeks [range 15-23 + 6]. Of the 38 women with PPROM, 22 (A) had spontaneous PPROM and 16 (B) underwent an invasive procedure during pregnancy. Expectant management was applied to 25 women: 12 (13 fetuses) from group A and 13 (16 fetuses) from group B. Median latency from PPROM to delivery was 35 days [range 1-163 days]. The two groups showed significant differences. The overall survival rate was 59% (17 fetuses) and three babies from group A died in the hospital. Survival rate of infants discharged from hospital was 48% (14/29). Of 14 surviving infants, 71% had a normal neurological and developmental outcome at four years. Only two infants from group A survived without obvious sequelae. Conclusion. Pregnancy after iatrogenic PPROM had a better prognosis than after spontaneous PPROM. Intensive management with corticosteroids and antibiotics appeared to be helpful. Neonatal survival in spontaneous PPROM before 24 weeks remained very poor and discussing pregnancy termination in these cases seems legitimate.