早产和围产期胎膜早破的管理和干预:综述。

IF 4.3 4区 医学 Q1 OBSTETRICS & GYNECOLOGY Obstetrical & Gynecological Survey Pub Date : 2023-11-01 DOI:10.1097/OGX.0000000000001198
Amy Phillips, Megan Pagan, Alex Smith, Megan Whitham, Everett F Magann
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引用次数: 0

摘要

重要性:胎膜早破(periviable and previable premature rupture of membranes,pPPROM)在客观上时有发生:本综述旨在描述胎膜早破患者的病因、风险因素、管理策略、新生儿和产妇结局以及复发风险:证据获取:对 PubMed、Web of Science 和 CINAHL 进行了检索,检索年限不限。使用的检索词包括 "previable "或 "periviable "和 "fetal membranes "或 "premature rupture "或 "PROM "或 "PPROM"。搜索仅限于英语:结果:共发现 181 篇文章,其中 41 篇为综述基础。发现了多种导致早产儿宫颈管破裂的风险因素,但其预测价值仍然很低。通常在胎儿妊娠 23-24 周时采取的干预措施,在前置胎儿期和围产期并没有改善预后的效果。随着时间的推移,新生儿的预后有所改善,但无严重发病的存活率仍然很低。事实证明,发生早产儿窒息(pPPROM)时胎龄较晚和潜伏期较长与预后改善有关:围产期和先兆胎膜早破是不常见的妊娠事件,但新生儿预后仍然很差,而且对妊娠期大于 24 周的胎膜早破进行常规干预并未证明是有益的。两个最可靠的预后指标是发生胎膜早破时的胎龄和潜伏期的长度。
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Management and Interventions in Previable and Periviable Preterm Premature Rupture of Membranes: A Review.

Importance: Periviable and previable premature rupture of membranes (pPPROM) occurs in <1% of pregnancies but can have devastating consequences for the mother and the fetus. Understanding risk factors, possible interventions, and both maternal and neonatal outcomes will improve the counseling and care provided for these patients.

Objective: The aim of this review is to describe the etiology, risk factors, management strategies, neonatal and maternal outcomes, and recurrence risk for patients experiencing pPPROM.

Evidence acquisition: A PubMed, Web of Science, and CINAHL search was undertaken with unlimited years searched. The search terms used included "previable" OR "periviable" AND "fetal membranes" OR "premature rupture" OR "PROM" OR "PPROM." The search was limited to English language.

Results: There were 181 articles identified, with 41 being the basis of review. Multiple risk factors for pPPROM have been identified, but their predictive value remains low. Interventions that are typically used once the fetus reaches 23 to 24 weeks of gestation have not been shown to improve outcomes when used in the previable and periviable stage. Neonatal outcomes have improved over time, but survival without severe morbidity remains low. Later gestational age at the time of pPPROM and longer latency period have been shown to be associated with improved outcomes.

Conclusions and relevance: Periviable and previable premature rupture of membranes are uncommon pregnancy events, but neonatal outcomes remain poor, and routine interventions for PPROM >24 weeks of gestation have not proven beneficial. The 2 most reliable prognostic indicators are gestational age at time of pPPROM and length of the latency period.

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来源期刊
CiteScore
2.70
自引率
3.20%
发文量
245
审稿时长
>12 weeks
期刊介绍: ​Each monthly issue of Obstetrical & Gynecological Survey presents summaries of the most timely and clinically relevant research being published worldwide. These concise, easy-to-read summaries provide expert insight into how to apply the latest research to patient care. The accompanying editorial commentary puts the studies into perspective and supplies authoritative guidance. The result is a valuable, time-saving resource for busy clinicians.
期刊最新文献
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