{"title":"早产晚期的早产儿猝死综合症:期待管理的论据。","authors":"Derek Lee, Tara A Lynch","doi":"10.1016/j.ajogmf.2024.101563","DOIUrl":null,"url":null,"abstract":"<p><p>Preterm prelabor rupture of membranes (PPROM) is associated with significant neonatal risks. When PPROM occurs during the late preterm period (between 34 0/7 and 36 6/7 weeks gestation), the optimal gestational age for delivery is unclear and varies by regional practice. In 2020 the American College of Obstetrician and Gynecologists (ACOG) published guidelines indicating that both expectant management and immediate delivery were considered reasonable options. Historically, studies that examined the topic of expectant management versus immediate delivery of PPROM after 34 weeks supported immediate delivery based on an observed increased risk of infectious complications without any benefit to neonatal outcome. However, these studies were small and were underpowered to detect a meaningful difference in neonatal outcomes. In this review, we examine six randomized controlled trials and two meta-analyses of randomized controlled trials that investigated neonatal and maternal outcomes of expectant management versus immediate delivery of late preterm PROM. Included in this analysis are three recent randomized controlled trials (PPROMEXIL, PPROMEXIL2, and PPROMT) and two meta-analyses that demonstrate a decreased risk of respiratory distress syndrome and NICU admission rate with expectant management. This is counterbalanced by an increased risk of chorioamnionitis with expectant management, but definitions of chorioamnionitis are variable in the trials with unclear generalizability of the outcome across the trials. Additional analysis with a childhood outcome study showed no significant difference in neurodevelopment in infants born to expectant management of late preterm PROM, and an economic analysis found that expectant management was associated with lower delivery and neonatal costs. Overall, we support expectant management of late preterm PROM if maternal and fetal status are stable and there are no contraindications to expectant management but not extending beyond 37 0/7 weeks gestation.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101563"},"PeriodicalIF":3.8000,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"PPROM in the late preterm period: an argument for expectant management.\",\"authors\":\"Derek Lee, Tara A Lynch\",\"doi\":\"10.1016/j.ajogmf.2024.101563\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Preterm prelabor rupture of membranes (PPROM) is associated with significant neonatal risks. When PPROM occurs during the late preterm period (between 34 0/7 and 36 6/7 weeks gestation), the optimal gestational age for delivery is unclear and varies by regional practice. In 2020 the American College of Obstetrician and Gynecologists (ACOG) published guidelines indicating that both expectant management and immediate delivery were considered reasonable options. Historically, studies that examined the topic of expectant management versus immediate delivery of PPROM after 34 weeks supported immediate delivery based on an observed increased risk of infectious complications without any benefit to neonatal outcome. However, these studies were small and were underpowered to detect a meaningful difference in neonatal outcomes. In this review, we examine six randomized controlled trials and two meta-analyses of randomized controlled trials that investigated neonatal and maternal outcomes of expectant management versus immediate delivery of late preterm PROM. Included in this analysis are three recent randomized controlled trials (PPROMEXIL, PPROMEXIL2, and PPROMT) and two meta-analyses that demonstrate a decreased risk of respiratory distress syndrome and NICU admission rate with expectant management. This is counterbalanced by an increased risk of chorioamnionitis with expectant management, but definitions of chorioamnionitis are variable in the trials with unclear generalizability of the outcome across the trials. Additional analysis with a childhood outcome study showed no significant difference in neurodevelopment in infants born to expectant management of late preterm PROM, and an economic analysis found that expectant management was associated with lower delivery and neonatal costs. Overall, we support expectant management of late preterm PROM if maternal and fetal status are stable and there are no contraindications to expectant management but not extending beyond 37 0/7 weeks gestation.</p>\",\"PeriodicalId\":36186,\"journal\":{\"name\":\"American Journal of Obstetrics & Gynecology Mfm\",\"volume\":\" \",\"pages\":\"101563\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2024-11-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Obstetrics & Gynecology Mfm\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ajogmf.2024.101563\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Obstetrics & Gynecology Mfm","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ajogmf.2024.101563","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
PPROM in the late preterm period: an argument for expectant management.
Preterm prelabor rupture of membranes (PPROM) is associated with significant neonatal risks. When PPROM occurs during the late preterm period (between 34 0/7 and 36 6/7 weeks gestation), the optimal gestational age for delivery is unclear and varies by regional practice. In 2020 the American College of Obstetrician and Gynecologists (ACOG) published guidelines indicating that both expectant management and immediate delivery were considered reasonable options. Historically, studies that examined the topic of expectant management versus immediate delivery of PPROM after 34 weeks supported immediate delivery based on an observed increased risk of infectious complications without any benefit to neonatal outcome. However, these studies were small and were underpowered to detect a meaningful difference in neonatal outcomes. In this review, we examine six randomized controlled trials and two meta-analyses of randomized controlled trials that investigated neonatal and maternal outcomes of expectant management versus immediate delivery of late preterm PROM. Included in this analysis are three recent randomized controlled trials (PPROMEXIL, PPROMEXIL2, and PPROMT) and two meta-analyses that demonstrate a decreased risk of respiratory distress syndrome and NICU admission rate with expectant management. This is counterbalanced by an increased risk of chorioamnionitis with expectant management, but definitions of chorioamnionitis are variable in the trials with unclear generalizability of the outcome across the trials. Additional analysis with a childhood outcome study showed no significant difference in neurodevelopment in infants born to expectant management of late preterm PROM, and an economic analysis found that expectant management was associated with lower delivery and neonatal costs. Overall, we support expectant management of late preterm PROM if maternal and fetal status are stable and there are no contraindications to expectant management but not extending beyond 37 0/7 weeks gestation.
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.