Preterm premature rupture of membranes in the late preterm period: an argument against expectant management

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm Pub Date : 2025-03-01 DOI:10.1016/j.ajogmf.2025.101619

Ghamar Bitar MD, Baha M. Sibai MD

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Abstract

Preterm premature rupture of membranes is defined as the leakage of amniotic fluid through the cervical os before 37 weeks of gestation and before the onset of labor and complicates nearly 3% of deliveries and 30% of indicated late preterm deliveries. The current management of preterm premature rupture of membranes, which occurs between 34 and 36 weeks of gestation, has pivoted from recommending delivery to recommending either delivery or expectant management because of a large trial that evaluated these management strategies. The potential neonatal benefits of expectant management, reducing complications of prematurity, must be weighed with the maternal risks (and, therefore, attached neonatal risks) of prolonging the gestation under close surveillance. Proceeding towards delivery is recommended for preterm premature rupture of membranes occurring at or later than 34 weeks gestation, given the higher risk of maternal complications, specifically hemorrhage and infection, with expectant management. Furthermore, limited evidence exists to prove the increased risks of adverse neonatal outcomes, including sepsis or composite neonatal morbidity, with immediate delivery compared with expectant management.

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早产晚期胎膜早破：反对准管理的争论。

胎膜早破的定义是在妊娠37周之前和分娩开始之前羊水通过子宫颈口渗漏，导致近3%的分娩和30%的晚期早产并发症。由于一项大型试验评估了这些管理策略，目前对发生在妊娠34至36周之间的胎膜早破的管理已经从建议分娩转向建议分娩或待产管理。准产管理的潜在新生儿益处，减少早产并发症，必须与密切监测下延长妊娠的产妇风险（因此，附加的新生儿风险）进行权衡。考虑到产妇并发症（特别是出血和感染）的风险较高，建议在妊娠34周或更晚发生胎膜早破时进行分娩。此外，有限的证据表明，与准产相比，立即分娩会增加新生儿不良结局的风险，包括败血症或新生儿综合发病率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Obstetrics & Gynecology Mfm Medicine-Medicine (all)

CiteScore

7.40

自引率

3.20%

发文量

254

审稿时长

40 days

期刊介绍： The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including: Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women. Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health. Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child. Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby. Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.