晚期早产胎膜早破妇女的胎龄与围产期结局之间的关系。

IF 1.5 4区 医学 Q3 OBSTETRICS & GYNECOLOGY American journal of perinatology Pub Date : 2024-12-01 Epub Date: 2024-05-16 DOI:10.1055/a-2328-6192
Eleanor M Schmidt, Jacqueline M Powell, Bharti Garg, Aaron B Caughey
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引用次数: 0

摘要

目的:美国妇产科协会建议将早产儿预产期延长至 34 周。新数据显示,延长至 37 周可能会改善新生儿预后,减少与早产相关的问题。本研究旨在评估患有早产儿猝死症的妇女在不同孕周的新生儿不良预后:研究设计:使用关联的生命统计数据和 ICD-9 数据进行了一项回顾性队列研究。分娩时的胎龄从 32 周到 36 周不等。研究结果包括新生儿重症监护室入院时间超过 24 小时、新生儿败血症、呼吸窘迫综合征、坏死性小肠结肠炎、脑室内出血和新生儿死亡。统计比较采用了多变量回归分析和卡方检验:在这组 28,891 例分娩中,随着胎龄的增加,所有研究的新生儿不良结局均有统计学意义上的显著下降,但新生儿败血症并未增加。32周时,93%的新生儿在新生儿重症监护室的时间超过24小时,而34周时为81%,36周时为22%(P结论:在发生早产儿猝死症的情况下,较晚的胎龄与新生儿不良结局发生率的降低有关,但新生儿败血症的发生率并没有增加。
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Association between Gestational Age and Perinatal Outcomes in Women with Late Preterm Premature Rupture of Membranes.

Objective:  The American College of Obstetricians and Gynecologists (ACOG) suggests expectant management until 34 weeks for patients with preterm premature rupture of membranes (PPROM). New data suggest extending to 37 weeks might enhance neonatal outcomes, reducing prematurity-linked issues. This study aims to assess adverse neonatal outcomes across gestational ages in women with PPROM.

Study design:  A retrospective cohort study was performed using linked vital statistics and the International Classification of Diseases, Ninth Revision data. Gestational age at delivery ranged from 32 to 36 weeks. Outcomes include neonatal intensive care unit (NICU) admission >24 hours, neonatal sepsis, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Multivariate regression analyses and chi-square tests were employed for statistical comparisons.

Results:  In this cohort of 28,891 deliveries, there was a statistically significant decline in all studied adverse neonatal outcomes with increasing gestational age, without an increase in neonatal sepsis. At 32 weeks, 93% of newborns were in the NICU >24 hours compared with 81% at 34 weeks and 22% at 36 weeks (p < 0.001). At 32 weeks, 20% had neonatal sepsis compared with 11% at 34 weeks and 3% at 36 weeks (p < 0.001). At 32 weeks, 67% had respiratory distress syndrome compared with 44% at 34 weeks and 12% at 36 weeks (p < 0.001).

Conclusion:  In the setting of PPROM, later gestational age at delivery is associated with decreased rates of adverse neonatal outcomes without an increase in neonatal sepsis.

Key points: · The ACOG recommends expectant management until 34 weeks for patients with PPROM.. · However, expectant management to 37 weeks might improve neonatal outcomes.. · Later gestational age at delivery was associated with decreased rates of adverse neonatal outcomes.. · Later gestational age at delivery was not associated with an increase in neonatal sepsis.. · The management of PPROM is complex and should be individualized..

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来源期刊
American journal of perinatology
American journal of perinatology 医学-妇产科学
CiteScore
5.90
自引率
0.00%
发文量
302
审稿时长
4-8 weeks
期刊介绍: The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.
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