Abstract：
OBJECTIVE: Counseling of pregnancies complicated by pre- and periviable premature rupture of membranes to reach shared decision-making is challenging, and the current limited evidence hampers the robustness of the information provided. This study aimed to elucidate the rate of obstetrical and neonatal outcomes after expectant management for premature rupture of membranes occurring before or at the limit of viability.
METHODS: Medline, Embase, CINAHL, and Web of Science databases were searched electronically up to September 2023.
METHODS: Our study included both prospective and retrospective studies of singleton pregnancies with premature rupture of membranes before and at the limit of viability (ie, occurring between 14 0/7 and 24 6/7 weeks of gestation).
METHODS: Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. Moreover, our study used meta-analyses of proportions to combine data and reported pooled proportions. Given the clinical heterogeneity, a random-effects model was used to compute the pooled data analyses. This study was registered with the International Prospective Register of Systematic Reviews database (registration number: CRD42022368029).
RESULTS: The pooled proportion of termination of pregnancy was 32.3%. After the exclusion of cases of termination of pregnancy, the rate of spontaneous miscarriage or fetal demise was 20.1%, whereas the rate of live birth was 65.9%. The mean gestational age at delivery among the live-born cases was 27.3 weeks, and the mean latency between premature rupture of membranes and delivery was 39.4 days. The pooled proportion of cesarean deliveries was 47.9% of the live-born cases. Oligohydramnios occurred in 47.1% of cases. Chorioamnionitis occurred in 33.4% of cases, endometritis in 7.0%, placental abruption in 9.2%, and postpartum hemorrhage in 5.3%. Hysterectomy was necessary in 1.2% of cases. Maternal sepsis occurred in 1.5% of cases, whereas no maternal death was reported in the included studies. When focusing on neonatal outcomes, the mean birthweight was 1022.8 g in live-born cases. The neonatal intensive care unit admission rate was 86.3%, respiratory distress syndrome was diagnosed in 66.5% of cases, pulmonary hypoplasia or dysplasia was diagnosed in 24.0% of cases, and persistent pulmonary hypertension was diagnosed in 40.9% of cases. Of the surviving neonates, the other neonatal complications included necrotizing enterocolitis in 11.1%, retinopathy of prematurity in 27.1%, and intraventricular hemorrhage in 17.5%. Neonatal sepsis occurred in 30.2% of cases, and the overall neonatal mortality was 23.9%. The long-term follow-up at 2 to 4 years was normal in 74.1% of the available cases.
CONCLUSIONS: Premature rupture of membranes before or at the limit of viability was associated with a great burden of both obstetrical and neonatal complications, with an impaired long-term follow-up at 2 to 4 years in almost 30% of cases, representing a clinical challenge for both counseling and management. Our data are useful when initially approaching such patients to offer the most comprehensive possible scenario on short- and long-term outcomes of this condition and to help parents in shared decision-making. El resumen está disponible en Español al final del artículo.
METHODS: Medline, Embase, CINAHL, and Web of Science databases were searched electronically up to September 2023.
METHODS: Our study included both prospective and retrospective studies of singleton pregnancies with premature rupture of membranes before and at the limit of viability (ie, occurring between 14 0/7 and 24 6/7 weeks of gestation).
METHODS: Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. Moreover, our study used meta-analyses of proportions to combine data and reported pooled proportions. Given the clinical heterogeneity, a random-effects model was used to compute the pooled data analyses. This study was registered with the International Prospective Register of Systematic Reviews database (registration number: CRD42022368029).
RESULTS: The pooled proportion of termination of pregnancy was 32.3%. After the exclusion of cases of termination of pregnancy, the rate of spontaneous miscarriage or fetal demise was 20.1%, whereas the rate of live birth was 65.9%. The mean gestational age at delivery among the live-born cases was 27.3 weeks, and the mean latency between premature rupture of membranes and delivery was 39.4 days. The pooled proportion of cesarean deliveries was 47.9% of the live-born cases. Oligohydramnios occurred in 47.1% of cases. Chorioamnionitis occurred in 33.4% of cases, endometritis in 7.0%, placental abruption in 9.2%, and postpartum hemorrhage in 5.3%. Hysterectomy was necessary in 1.2% of cases. Maternal sepsis occurred in 1.5% of cases, whereas no maternal death was reported in the included studies. When focusing on neonatal outcomes, the mean birthweight was 1022.8 g in live-born cases. The neonatal intensive care unit admission rate was 86.3%, respiratory distress syndrome was diagnosed in 66.5% of cases, pulmonary hypoplasia or dysplasia was diagnosed in 24.0% of cases, and persistent pulmonary hypertension was diagnosed in 40.9% of cases. Of the surviving neonates, the other neonatal complications included necrotizing enterocolitis in 11.1%, retinopathy of prematurity in 27.1%, and intraventricular hemorrhage in 17.5%. Neonatal sepsis occurred in 30.2% of cases, and the overall neonatal mortality was 23.9%. The long-term follow-up at 2 to 4 years was normal in 74.1% of the available cases.
CONCLUSIONS: Premature rupture of membranes before or at the limit of viability was associated with a great burden of both obstetrical and neonatal complications, with an impaired long-term follow-up at 2 to 4 years in almost 30% of cases, representing a clinical challenge for both counseling and management. Our data are useful when initially approaching such patients to offer the most comprehensive possible scenario on short- and long-term outcomes of this condition and to help parents in shared decision-making. El resumen está disponible en Español al final del artículo.
摘要：
背景：为达成共同决策而进行的妊娠咨询是具有挑战性的，当前，有限的证据阻碍了所提供信息的稳健性。
目的：阐明对胎膜早破（PROM）在存活前或存活极限时进行预期处理后的产科和新生儿结局的发生率。
方法：Medline，Embase,截至2023年9月，对Cinahl和WebofScience数据库进行了电子搜索。我们包括在生存能力之前和极限时进行的PROM单胎妊娠的前瞻性和回顾性研究（即，发生在妊娠14/0至24/6周之间)。纳入研究的质量评估使用纽卡斯尔-渥太华量表进行队列研究。我们使用比例的荟萃分析来组合数据和报告的汇总比例。鉴于临床异质性，使用随机效应模型计算合并数据分析.该研究在PROSPERO数据库(CRD42022368029)中注册。
结果：合并终止妊娠（TOP）的比例为32.3％。排除TOP病例后，自然流产或胎儿死亡率为20.1%，而活产率为持续怀孕的65.9%。活产病例分娩时的平均胎龄为27.26周，胎膜早破与分娩之间的平均潜伏期为39.40天。剖宫产的合并比例为47.9％。47.1％的病例发生羊水过少。33.4%的病例发生绒毛膜羊膜炎；7%的病例发生子宫内膜炎，胎盘早剥9.2%，产后出血5.3%。1.2％的病例需要进行子宫切除术。在纳入的研究中，孕产妇败血症发生在1.5％的病例中，而没有孕产妇死亡报告。当关注新生儿结局时，活出生病例的平均出生体重为1022.85克。NICU入院率为86.3%,RDS并发66.5%；24.0%的病例诊断为肺发育不全或发育不良，40.9%的病例诊断为持续肺动脉高压。其他新生儿并发症包括11.1％的坏死性小肠结肠炎，ROP为27.1%,IVH在17.5％的存活新生儿中。新生儿败血症并发病例占30.2%，新生儿总死亡率为23.9%。在74.1%的可用病例中，2至4年的长期随访是正常的。
结论：存活前或存活极限时的胎膜早破与产科和新生儿并发症的高负担相关，在近30％的病例中，2至4年的长期随访受损，因此对咨询和管理都是临床挑战。这些数据在首次接触此类患者时很有用，可以提供有关这种情况的短期和长期结果的最全面的情况，并帮助父母共同决策。
目的：阐明对胎膜早破（PROM）在存活前或存活极限时进行预期处理后的产科和新生儿结局的发生率。
方法：Medline，Embase,截至2023年9月，对Cinahl和WebofScience数据库进行了电子搜索。我们包括在生存能力之前和极限时进行的PROM单胎妊娠的前瞻性和回顾性研究（即，发生在妊娠14/0至24/6周之间)。纳入研究的质量评估使用纽卡斯尔-渥太华量表进行队列研究。我们使用比例的荟萃分析来组合数据和报告的汇总比例。鉴于临床异质性，使用随机效应模型计算合并数据分析.该研究在PROSPERO数据库(CRD42022368029)中注册。
结果：合并终止妊娠（TOP）的比例为32.3％。排除TOP病例后，自然流产或胎儿死亡率为20.1%，而活产率为持续怀孕的65.9%。活产病例分娩时的平均胎龄为27.26周，胎膜早破与分娩之间的平均潜伏期为39.40天。剖宫产的合并比例为47.9％。47.1％的病例发生羊水过少。33.4%的病例发生绒毛膜羊膜炎；7%的病例发生子宫内膜炎，胎盘早剥9.2%，产后出血5.3%。1.2％的病例需要进行子宫切除术。在纳入的研究中，孕产妇败血症发生在1.5％的病例中，而没有孕产妇死亡报告。当关注新生儿结局时，活出生病例的平均出生体重为1022.85克。NICU入院率为86.3%,RDS并发66.5%；24.0%的病例诊断为肺发育不全或发育不良，40.9%的病例诊断为持续肺动脉高压。其他新生儿并发症包括11.1％的坏死性小肠结肠炎，ROP为27.1%,IVH在17.5％的存活新生儿中。新生儿败血症并发病例占30.2%，新生儿总死亡率为23.9%。在74.1%的可用病例中，2至4年的长期随访是正常的。
结论：存活前或存活极限时的胎膜早破与产科和新生儿并发症的高负担相关，在近30％的病例中，2至4年的长期随访受损，因此对咨询和管理都是临床挑战。这些数据在首次接触此类患者时很有用，可以提供有关这种情况的短期和长期结果的最全面的情况，并帮助父母共同决策。
