Obstetrical & Gynecological Survey最新文献

{"title":"Diagnosis and Management of Macrosomia and Shoulder Dystocia: A Comprehensive Review of Major Guidelines.","authors":"Sonia Giouleka, Ioannis Tsakiridis, Elpida Ralli, Apostolos Mamopoulos, Ioannis Kalogiannidis, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/ogx.0000000000001253","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001253","url":null,"abstract":"Macrosomia represents the most significant risk factor of shoulder dystocia (SD), which is a severe and emergent complication of vaginal delivery. They are both associated with adverse pregnancy outcomes.","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"9 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140625605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cell-Free DNA Screening for Single-Gene Disorders.","authors":"Brighton S Goodhue, Sky E Danity, Neeta Vora, Jeffrey A Kuller, Matthew R Grace","doi":"10.1097/OGX.0000000000001250","DOIUrl":"10.1097/OGX.0000000000001250","url":null,"abstract":"<p><strong>Importance: </strong>In pregnancy, cell-free DNA (cfDNA) represents short fragments of placental DNA released into the maternal blood stream through natural cell death. Noninvasive prenatal screening with cfDNA is commonly used in pregnancy to screen for common aneuploidies. This technology continues to evolve, and laboratories now offer cfDNA screening for single-gene disorders.</p><p><strong>Objective: </strong>This article aims to review cfDNA screening for single-gene disorders including the technology, current syndromes for which screening may be offered, limitations, and current recommendations.</p><p><strong>Evidence acquisition: </strong>Original research articles, review articles, laboratory white papers, and society guidelines were reviewed.</p><p><strong>Results: </strong>Cell-free DNA screening for single-gene disorders is not currently recommended by medical societies. There may be a role in specific circumstances and only after comprehensive pretest counseling. It can be considered in the setting of some fetal ultrasound anomalies, and usually only after diagnostic testing is offered and declined.</p><p><strong>Conclusions: </strong>Given the limitations of using cfDNA screening for single-gene disorders, caution is recommended when considering these tests. It should only be offered with involvement of a reproductive genetic counselor, medical geneticist, or maternal fetal medicine specialist to ensure comprehensive counseling and appropriate utilization.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 3","pages":"176-181"},"PeriodicalIF":6.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Anomalies in Multiple Pregnancy: A Literature Review.","authors":"Jae Eun Shin, Hyun Sun Ko, Jin Young Bae, Won Joon Seong, Tae Gyu Ahn, You Jung Han, Geum Joon Cho, In Yang Park","doi":"10.1097/OGX.0000000000001251","DOIUrl":"10.1097/OGX.0000000000001251","url":null,"abstract":"<p><strong>Importance: </strong>Multiple pregnancy is relatively common in many countries and is associated with various pregnancy complications, including preterm birth, low birth weight, and congenital anomalies. In particular, a poorer prognosis has been reported when congenital anomalies overlap with other pregnancy complications in multiple pregnancy compared with singleton pregnancy.</p><p><strong>Objective: </strong>This study reviews the characteristics of congenital anomalies that occur in multiple gestations as compared with singleton pregnancies.</p><p><strong>Evidence acquisition: </strong>An extensive manual search of major electronic databases was conducted in June 2023. This literature review provides a comprehensive coverage of the congenital anomalies in multiple pregnancy.</p><p><strong>Results: </strong>Most studies have shown that multiple gestations are associated with an increased risk of congenital anomalies compared with singleton pregnancies. In addition, higher rates of congenital anomalies and concordance have been observed in monozygotic versus dizygotic twins. The effect of assisted reproductive therapies on the risk of congenital anomalies appears to be smaller in multiple gestations than in singleton pregnancies.</p><p><strong>Conclusions: </strong>Multiple pregnancy is significantly associated with an increased risk of congenital anomalies.</p><p><strong>Relevance: </strong>This review provides obstetrical providers with the requisite knowledge to offer appropriate antenatal care and prenatal anomaly screening to patients with multiple pregnancies.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 3","pages":"167-175"},"PeriodicalIF":6.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Luteal Phase Defects and Progesterone Supplementation.","authors":"Lucas C Collins, Luke A Gatta, Sarah K Dotters-Katz, Jeffrey A Kuller, Danny J Schust","doi":"10.1097/OGX.0000000000001242","DOIUrl":"10.1097/OGX.0000000000001242","url":null,"abstract":"<p><strong>Importance: </strong>Luteal phase defects (LPDs), or an insufficiency of progesterone production during the luteal phase of the menstrual cycle, have been identified as a potential cause of recurrent pregnancy loss (RPL), but its exact contribution to RPL is not well-defined. In addition, the role of exogenous progesterone supplementation during pregnancy remains controversial.</p><p><strong>Objective: </strong>The goal of this review is to provide an updated, evidence-based summary of LPD, including prevalence and potential pathophysiologic mechanisms, and to explore the current controversies regarding progesterone supplementation for management and treatment of RPL.</p><p><strong>Evidence acquisition: </strong>A literature review identified relevant research using a PubMed search, Cochrane summaries, review articles, textbook chapters, databases, and society guidelines.</p><p><strong>Results: </strong>Endogenous progesterone plays a crucial role in the first trimester of pregnancy, and therefore, insufficiency may contribute to RPL. However, the precise relationship between LPD and RPL remains unclear. Luteal phase defect is primarily a clinical diagnosis based on a luteal phase less than 10 days. Although there may be a possibility of incorporating a combined clinical and biochemical approach in defining LPD, the current lack of validated diagnostic criteria creates a challenge for its routine incorporation in the workup of infertility. Moreover, no treatment modality has demonstrated efficacy in improving fertility outcomes for LPD patients, including progesterone supplementation, whose inconsistent data do not sufficiently support its routine use, despite its minimal risk. It is imperative that women diagnosed with LPD should be worked up for other potential conditions that may contribute to a shortened luteal phase. Future work needs to focus on identifying a reproducible diagnostic test for LPD to guide treatment.</p><p><strong>Conclusions and relevance: </strong>Currently, the perceived relationship between LPD and RPL is challenged by conflicting data. Therefore, patients with an abnormal luteal phase should undergo a thorough workup to address any other potential etiologies. Although supplemental progesterone is commonly utilized for treatment of LPD and RPL, inconsistent supporting data call for exogenous hormone therapy to be only used in a research setting or after a thorough discussion of its shortcomings.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 2","pages":"122-128"},"PeriodicalIF":6.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postnatal Care: A Comparative Review of Guidelines.","authors":"Sonia Giouleka, Ioannis Tsakiridis, Nikolaos Kostakis, Eirini Boureka, Apostolos Mamopoulos, Ioannis Kalogiannidis, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001224","DOIUrl":"10.1097/OGX.0000000000001224","url":null,"abstract":"<p><strong>Importance: </strong>Postnatal care refers to the ongoing health care provision of both the mother and her offspring and contributes to the timely identification and effective management of complications in the postpartum period, to secure maternal and infant short- and long-term well-being.</p><p><strong>Objective: </strong>The aim of this study was to review and compare the most recently published influential guidelines on postnatal care practices.</p><p><strong>Evidence acquisition: </strong>A comparative review of guidelines from the American College of Obstetricians and Gynecologists, the World Health Organization, the National Institute for Health and Care Excellence, and the Public Health Agency of Canada regarding postnatal care was conducted.</p><p><strong>Results: </strong>There is a consensus among the reviewed guidelines regarding the importance of health care provision in the postpartum period, including home visits and midwifery services, the use of telemedicine for the facilitation of communication with the patient, and the appropriate preparation for discharge, as well as the discharge criteria. All medical societies also agree on the clinical aspects that should be evaluated at each postnatal visit, although discrepancies exist with regard to the contact schedule. In addition, there is consistency regarding the management of postpartum infections, perineal pain, fecal and urinary incontinence, and physical activity guidance. Mental health issues should be addressed at each postnatal visit, according to all guidelines, but there is disagreement regarding routine screening for depression. As for the optimal interpregnancy interval, the American College of Obstetricians and Gynecologists recommends avoiding pregnancy for at least 6 months postpartum, whereas the National Institute for Health and Care Excellence recommends a 12-month interval. There is no common pathway regarding the recommended contraceptive methods, the nutrition guidance, and the postpartum management of pregnancy complications. Of note, the World Health Organization alone provides recommendations concerning the prevention of specific infections during the postnatal period.</p><p><strong>Conclusions: </strong>Postnatal care remains a relatively underserved aspect of maternity care, although the puerperium is a critical period for the establishment of motherhood and the transition to primary care. Thus, the development of consistent international protocols for the optimal care and support of women during the postnatal period seems of insurmountable importance to safely guide clinical practice and subsequently reduce maternal and neonatal morbidity.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 2","pages":"105-121"},"PeriodicalIF":6.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature.","authors":"Inshirah Sgayer, Shirin Dabbah, Rola Khamisy Farah, Maya Wolf, Nadine Ashkar, Lior Lowenstein, Marwan Odeh","doi":"10.1097/OGX.0000000000001205","DOIUrl":"10.1097/OGX.0000000000001205","url":null,"abstract":"<p><strong>Importance: </strong>Uterine rupture is defined as a nonsurgical disruption of all layers of the uterus. Most ruptures occur in the presence of a scar, usually secondary to a previous cesarean delivery. Rupture of an unscarred uterus is rare and is associated with severe maternal and neonatal outcomes.</p><p><strong>Objective: </strong>To outline the literature on potential predisposing factors, clinical findings, and maternal and fetal outcomes of a rupture of an unscarred uterus.</p><p><strong>Evidence acquisition: </strong>PubMed was searched for the phrases \"uterine rupture,\" \"unscarred,\" and \"spontaneous.\" Individual case reports, retrospective case series, and review articles in English between 1983 and 2020 were included.</p><p><strong>Results: </strong>We found 84 case reports in 79 articles. The mean maternal age was 29.3 (SD, 5.7) years; 38 women (45.2%) were nulliparous. Uterine rupture occurred in 37% of the women at term; in 9.9%, the gestational age was ≤12 weeks. The most common clinical presentations were abdominal pain (77.4%), signs of hypovolemic shock (36.9%), fetal distress (31%), and vaginal bleeding (22.6%). The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor and a prior curettage procedure. The most frequently ruptured site was the body of the uterus. Hysterectomy managed 36.9% of the ruptures. Four women died (4.8%). Perinatal mortality was 50.6%. Perinatal death was higher in developing than developed countries.</p><p><strong>Conclusions and relevance: </strong>Although rare, spontaneous rupture of the unscarred uterus has serious consequences to the mother and the fetus and should be included in the differential diagnosis of acute abdomen in pregnancy.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"78 12","pages":"759-765"},"PeriodicalIF":6.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central Sensitization in Vulvodynia and Endometriosis: What Have We Been Overlooking So Far?","authors":"Giulia Emily Cetera, Camilla Erminia Maria Merli, Veronica Boero, Carlotta Caia, Federica Facchin, Giussy Barbara, Ermelinda Monti, Paolo Vercellini","doi":"10.1097/OGX.0000000000001183","DOIUrl":"10.1097/OGX.0000000000001183","url":null,"abstract":"<p><strong>Importance: </strong>Women experience more frequent and greater pain than men, although they receive less adequate treatment and are perceived as more anxious than males. Recent clinical research has lead to hypothesize a common etiology for overlapping chronic pain conditions and mood disorders, namely, central sensitization, which originates from an alteration of pain processing pathways in the central nervous system.</p><p><strong>Objective: </strong>The aim of this review was to collect all available evidence regarding the potential role of central sensitization in vulvodynia and endometriosis.</p><p><strong>Evidence acquisition: </strong>A systematic literature search was performed between July and August 2022 using the electronic database PubMed. The extracted data were summarized using a narrative approach.</p><p><strong>Results: </strong>Ten articles were chosen for the review. Participants' mean age was 39.2 years (SD = 5.1). Among serum markers of central sensitization, nitric oxide levels were greater in women with endometriosis than in controls, whereas brain-derived neurotrophic factor and S100B levels differed among pain conditions with structural anomalies and those without. Functional magnetic resonance imaging showed different resting state networks between patients with endometriosis and controls. In neurophysiology studies, cases had reduced pain thresholds, compared with healthy controls. Lastly, self-reported questionnaires suggested a central component of pain in women with endometriosis-related dyspareunia and associated bladder/pelvic floor tenderness.</p><p><strong>Conclusions and relevance: </strong>The management of vulvodynia and endometriosis may benefit from a new perspective, which considers their possible central etiology. It is compelling that treatment of pain starts to be considered a therapeutic goal in its own right.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"78 12","pages":"745-758"},"PeriodicalIF":6.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of Early-Onset Neonatal Group B Streptococcal Disease: A Comprehensive Review of Major Guidelines.","authors":"Eirini Boureka, Dimitrios Krasias, Ioannis Tsakiridis, Anna-Maria Karathanasi, Apostolos Mamopoulos, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001223","DOIUrl":"10.1097/OGX.0000000000001223","url":null,"abstract":"<p><strong>Importance: </strong>Group B <i>Streptococcus</i> (GBS) colonization during pregnancy is associated with significant neonatal morbidity and mortality and represents a major public health concern, often associated with poor screening and management.</p><p><strong>Objective: </strong>The aim of this study was to review and compare the most recently published influential guidelines on the screening and management of this clinical entity during antenatal and intrapartum periods.</p><p><strong>Evidence acquisition: </strong>A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada on the prevention of early-onset neonatal group B streptococcal disease was carried out.</p><p><strong>Results: </strong>There is a consensus among the reviewed guidelines regarding the optimal screening specimen type, indications for intrapartum antibiotic administration such as bacteriuria during pregnancy, clinical signs of chorioamnionitis or maternal pyrexia, and history of GBS-related neonatal disease. There is also agreement on several conditions where no intervention is recommended, that is, antepartum treatment of GBS and GBS-positive women with planned cesarean delivery and intact membranes. Controversy exists regarding the optimal screening time, with the Royal College of Obstetricians and Gynecologists stating against routine screening and on management strategies related to preterm labor and preterm prelabor rupture of membranes.</p><p><strong>Conclusions: </strong>The development of consistent international practice protocols for the timely screening of GBS and effective management of this clinical entity both during pregnancy and the intrapartum period seems of paramount importance to safely guide clinical practice and subsequently improve neonatal outcomes.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"78 12","pages":"766-774"},"PeriodicalIF":6.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Management of Osteoporosis: A Comprehensive Review of Guidelines.","authors":"Elpiniki Rentzeperi, Stavroula Pegiou, Ioannis Tsakiridis, Ioannis Kalogiannidis, Anargyros Kourtis, Apostolos Mamopoulos, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001181","DOIUrl":"10.1097/OGX.0000000000001181","url":null,"abstract":"<p><strong>Importance: </strong>Osteoporosis causes increased morbidity and mortality, and thus poses a significant economic burden to the health systems worldwide.</p><p><strong>Objective: </strong>The aim of this study was to review and compare the most recently published major guidelines on diagnosis and management of this common medical entity.</p><p><strong>Evidence acquisition: </strong>A thorough comparative review of the most influential guidelines from the RACGP (Royal Australian College of General Practitioners), the ESCEO-IOF (European Society for Clinical and Economic Aspects of Osteoporosis-International Osteoporosis Foundation), the NOGG (National Osteoporosis Guideline Group), the NAMS (North American Menopause Society), the ES (Endocrine Society), and the ACOG (American College of Obstetricians and Gynecologists) was conducted.</p><p><strong>Results: </strong>The reviewed guidelines generally agree on the definition, the criteria, and investigations used to diagnose osteoporosis. They also concur regarding the risk factors for osteoporosis and the suggested lifestyle modifications (calcium and vitamin D intake, normal body weight, reduction of alcohol consumption, and smoking cessation). However, there is lack of consensus on indications for fracture risk assessment in the general population and the exact indications for bone mineral density assessment. Referral to a bone specialist is reserved for complex cases of osteoporosis (NOGG, NAMS, and ACOG) or in case of inadequate access to care (RACGP). The use of hip protectors to reduce the risk of fractures is supported by RACGP, NOGG, and NAMS, solely for high-risk elderly patients in residential care settings. All guidelines reviewed recognize the efficacy of the pharmacologic agents (ie, bisphosphonates, denosumab, hormone therapy, and parathyroid hormone analogs). Nonetheless, recommendations regarding monitoring of pharmacotherapy differ, primarily in the case of bisphosphonates. The proposed intervals of repeat bone mineral density testing after initiation of drug therapy are set at 2 years (RACGP), 1-3 years (NAMS, ES, and ACOG), or 3-5 years (ESCEO-IOF and NOGG). All guidelines agree upon the restricted use of bone turnover markers only in bone specialist centers for treatment monitoring purposes. Finally, the definition of treatment failure varies among the reviewed guidelines.</p><p><strong>Conclusions: </strong>Osteoporosis is a distressing condition for women, mainly those of postmenopausal age. Thus, it seems of paramount importance to develop consistent international practice protocols for more cost-effective diagnostic and management techniques, in order to improve women's quality of life.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"78 11","pages":"657-681"},"PeriodicalIF":6.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and Interventions in Previable and Periviable Preterm Premature Rupture of Membranes: A Review.","authors":"Amy Phillips, Megan Pagan, Alex Smith, Megan Whitham, Everett F Magann","doi":"10.1097/OGX.0000000000001198","DOIUrl":"10.1097/OGX.0000000000001198","url":null,"abstract":"<p><strong>Importance: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Evidence acquisition: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions and relevance: </strong>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.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"78 11","pages":"682-689"},"PeriodicalIF":6.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}