Abstract：
OBJECTIVE: To determine whether equivocal prelabor rupture of membranes (PROM) cases are associated with adverse outcomes.
METHODS: A retrospective study was conducted in a tertiary medical center between July 2012 and March 2022. The cohort comprised all women diagnosed with term PROM (≥37 gestational weeks), divided into two groups. (1) Certain PROM-suggestive history of a watery vaginal discharge confirmed by visualization of fluid leaking from the cervix or pooling in the vagina on speculum examination. (2) Uncertain PROM-suggestive history of a watery vaginal discharge not supported by speculum examination. All patients were hospitalized and gave birth spontaneously or following either expectant management for up to 24 h from PROM or induction. The primary outcome measure was cesarean delivery (CD) rate. Secondary outcome measures were adverse maternal/neonatal events.
RESULTS: Of the 2012 women included in the study, 1750 had certain PROM and 262 uncertain PROM. CD rate was 5.8% in the certain PROM group and 8.8% in the uncertain PROM group; the difference was not statistically significant (P = 0.074). There was a significant between-group difference in the rate of CD due to failed induction on univariate analysis (0.69% vs 2.67%, respectively, P = 0.007), but it was not maintained on multivariate logistic regression (odds ratio 0.37, 95% confidence interval: 0.12-1.17). Other maternal and neonatal outcomes were similar in the two groups.
CONCLUSIONS: Our findings indicate that following the same management guidelines for equivocal cases of ruptured membranes as for confirmed cases of term PROM did not compromise maternal or fetal outcomes.
METHODS: A retrospective study was conducted in a tertiary medical center between July 2012 and March 2022. The cohort comprised all women diagnosed with term PROM (≥37 gestational weeks), divided into two groups. (1) Certain PROM-suggestive history of a watery vaginal discharge confirmed by visualization of fluid leaking from the cervix or pooling in the vagina on speculum examination. (2) Uncertain PROM-suggestive history of a watery vaginal discharge not supported by speculum examination. All patients were hospitalized and gave birth spontaneously or following either expectant management for up to 24 h from PROM or induction. The primary outcome measure was cesarean delivery (CD) rate. Secondary outcome measures were adverse maternal/neonatal events.
RESULTS: Of the 2012 women included in the study, 1750 had certain PROM and 262 uncertain PROM. CD rate was 5.8% in the certain PROM group and 8.8% in the uncertain PROM group; the difference was not statistically significant (P = 0.074). There was a significant between-group difference in the rate of CD due to failed induction on univariate analysis (0.69% vs 2.67%, respectively, P = 0.007), but it was not maintained on multivariate logistic regression (odds ratio 0.37, 95% confidence interval: 0.12-1.17). Other maternal and neonatal outcomes were similar in the two groups.
CONCLUSIONS: Our findings indicate that following the same management guidelines for equivocal cases of ruptured membranes as for confirmed cases of term PROM did not compromise maternal or fetal outcomes.
摘要：
目的：确定模棱两可的胎膜破裂（PROM）病例是否与不良结局相关。
方法：2012年7月至2022年3月在三级医疗中心进行了一项回顾性研究。该队列包括所有诊断为足月胎膜早破（≥37孕周）的妇女，分为两组。（1）某些PROM提示的水样阴道分泌物的病史，通过在窥器检查中从子宫颈漏出的液体或在阴道中积聚的可视化来证实。（2）窥器检查不支持的水样阴道分泌物的不确定PROM提示病史。所有患者均住院并自发分娩，或在PROM或诱导后进行长达24小时的期待治疗。主要结局指标是剖宫产（CD）率。次要结局指标为不良孕产妇/新生儿事件。
结果：在2012年纳入研究的女性中，1750有一定的PROM和262不确定的PROM。某些PROM组的CD发生率为5.8％，不确定PROM组的CD发生率为8.8％。差异无统计学意义（P=0.074）。在单因素分析中，由于诱导失败，CD的发生率在组间存在显着差异（0.69％vs2.67％，分别,P=0.007),但在多因素logistic回归(比值比0.37,95%置信区间:0.12-1.17)中并未得到维持.两组的其他孕产妇和新生儿结局相似。
结论：我们的研究结果表明，对于模棱两可的胎膜破裂病例和确诊的足月胎膜早破病例，遵循相同的治疗指南并不影响母体或胎儿的结局。
方法：2012年7月至2022年3月在三级医疗中心进行了一项回顾性研究。该队列包括所有诊断为足月胎膜早破（≥37孕周）的妇女，分为两组。（1）某些PROM提示的水样阴道分泌物的病史，通过在窥器检查中从子宫颈漏出的液体或在阴道中积聚的可视化来证实。（2）窥器检查不支持的水样阴道分泌物的不确定PROM提示病史。所有患者均住院并自发分娩，或在PROM或诱导后进行长达24小时的期待治疗。主要结局指标是剖宫产（CD）率。次要结局指标为不良孕产妇/新生儿事件。
结果：在2012年纳入研究的女性中，1750有一定的PROM和262不确定的PROM。某些PROM组的CD发生率为5.8％，不确定PROM组的CD发生率为8.8％。差异无统计学意义（P=0.074）。在单因素分析中，由于诱导失败，CD的发生率在组间存在显着差异（0.69％vs2.67％，分别,P=0.007),但在多因素logistic回归(比值比0.37,95%置信区间:0.12-1.17)中并未得到维持.两组的其他孕产妇和新生儿结局相似。
结论：我们的研究结果表明，对于模棱两可的胎膜破裂病例和确诊的足月胎膜早破病例，遵循相同的治疗指南并不影响母体或胎儿的结局。
