评估在足月分娩前胎膜破裂的情况下,立即诱导与期待管理对母婴结局的影响。
我们搜索了Medline数据库,Cochrane图书馆并咨询了国际准则。
在足月分娩前胎膜破裂的情况下,与期待管理相比,引产与胎膜破裂至分娩间隔较短相关,如果用催产素(LE2)进行诱导,前列腺素E2(LE2)或米索前列醇(LE2),但当使用Foley®导管(LE2)进行诱导时,渗透扩张器(LE2)或针刺(LE2)。迄今为止最有力的证据来自一项大型国际随机研究,TERMPROM研究,其中包括1992年至1995年期间的5000多名妇女。这项研究将催产素或前列腺素E2的立即诱导与长达96小时的预期管理进行了比较,然后用催产素或前列腺素E2诱导。立即诱导与新生儿感染率(LE1)下降无关,甚至在B链球菌阴道拭子(LE2)阳性的女性中。因此,可以在不增加新生儿感染风险的情况下提供期待管理(B级)。在TERMPROM研究(LE2)中,催产素诱导与子宫内感染和产后发热的风险降低相关。然而,这项研究对这一结果有显著的局限性(未知的链球菌B状态和预防性抗生素的低比率),在其他较小的研究中没有发现这种关联。前列腺素E2的诱导没有观察到这种降低。在TERMPROM研究中,诱导与剖宫产率(LE2)的增加或减少无关,无论平价(LE2)或Bishop成绩(LE3)。因此,可以在不增加剖宫产风险的情况下提出诱导(B级)。没有研究评估超过4天的预期管理。
在足月分娩前胎膜破裂的情况下,可以在不增加剖宫产风险的情况下提供引产(B级)。可以在不增加新生儿感染风险的情况下提供预期管理(B级),甚至在B链球菌阴道拭子阳性的女性中(专业共识)。因此,在告知她们与引产和期待管理相关的风险和收益(专业共识)之后,产房组织和妇女的偏好将指导最佳的引产时机。如果月经液或足月胎膜破裂>4天,必须提供归纳法(专业共识)。
To assess the effect of immediate induction versus expectant management on maternal and neonatal outcomes in case of term prelabor rupture of membranes.
We searched Medline Database, Cochrane Library and consulted international
guidelines.
In case of term prelabor rupture of membranes, induction of labor is associated with shorter rupture of membranes to delivery intervals when compared to expectant management, if induction is conducted with oxytocin (LE2), prostaglandin E2 (LE2) or misoprostol (LE2), but not when induction is conducted with Foley® catheter (LE2), osmotic dilatator (LE2) or acupuncture (LE2). The strongest evidence to date comes from a large international randomized study, the TERMPROM study, which included over 5000 women between 1992 and 1995. This study compared immediate induction with oxytocin or prostaglandin E2 to expectant management up to 96hours, followed by
induction by oxytocin or prostaglandin E2. Immediate induction was not associated with a decreased neonatal infection rate (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the neonatal infection risk (Grade B). Induction with oxytocin was associated with a decreased risk of intra-uterine infection and postpartum fever in the TERMPROM study (LE2), however, this study had significant limitations concerning this outcome (unknown streptococcus B status and low rate of prophylactic antibiotics), and this association was not found in other smaller studies. This decrease was not observed with induction by prostaglandin E2. In the TERMPROM study, induction was not associated with an increase or decrease in the rate of cesarean section (LE2), whatever the parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the cesarean section risk (Grade B). There is no study evaluating expectant management over 4 days.
In case of term prelabor rupture of membranes, induction can be offered without increasing the cesarean section risk (Grade B). Expectant management can be offered without increasing the neonatal infection risk (Grade B), even among women with a positive streptococcus B vaginal swab (Professional
consensus). The optimal moment of induction will therefore be guided by the maternity wards organization and women\'s preference after having informed them of the risks and benefits associated with induction and expectant management (Professional
consensus). In case of meconial fluid or term prelabor rupture of membranes>4 days, induction must be offered (Professional
consensus).