早产胎膜早破妇女的门诊治疗：一项回顾性多中心队列研究

摘要(中文译文)

早产前胎膜破裂会给母体和围产期带来风险，包括母体脓毒症、胎盘早剥、早产及其后遗症、围产期心理健康并发症以及死亡。其最佳管理方案尚未被充分了解。英国最新的指南建议门诊管理可能是合适的，但未给出监测频率或监测方式的指导，且此后的结局也未被充分了解。本研究旨在确定因早产前胎膜破裂而妊娠复杂化并在门诊接受照护的女性的监测实践和结局，并了解她们的经历。回顾性数据收集包括患者人口学特征、既往危险因素、诊断和门诊监测（包括母体观察指标、生化学和超声检查结果）、分娩结局及胎盘组织病理学。对女性的咨询评估在两个时间点进行：诊断时和由顾问医师首次复诊时。所有女性均被邀请参与一项服务评估。在六个单位中，233名女性因早产前胎膜破裂在门诊服务中接受照护。诊断时的中位孕龄为32周（IQR 28+1至34+3周）。34%的诊断不明确。各单位的结局咨询情况各不相同。41%的病例发生自发性早产，另有18%因疑似绒毛膜羊膜炎而早产分娩。所有单位均使用母体心率、体温、C反应蛋白和白细胞计数来监测感染，然而分娩时的绝对值或这些指标的任何趋势均不能预测组织学绒毛膜羊膜炎。大多数女性认为其门诊照护是可以接受的，但指出了所提供情感支持的不足。

Abstract

Preterm prelabour rupture of the membranes poses maternal and perinatal risks including maternal sepsis, placental abruption, preterm labour and its sequelae, perinatal mental health complications, and mortality. Optimum management is not well understood. Most recent UK guidance suggested outpatient management may be appropriate, but guidance was not given on frequency or mode of monitoring, and outcomes following this are not well understood. This study aimed to determine monitoring practices and outcomes of women whose pregnancies complicated by preterm prelabour rupture of the membrane who are cared for in the outpatient setting, and to understand their experience. Retrospective data collection including patient demographics, preexisting risk factors, diagnosis and outpatient monitoring (including maternal observations, biochemistry and ultrasound findings), delivery outcomes and placental histopathology. Counselling of women was assessed at two timepoints: diagnosis and first review by a consultant. All women were invited to participate in a service evaluation. Across six units, 233 women were cared for in outpatient services for PPROM. Median gestation at diagnosis was 32 weeks (IQR 28 + 1 - 34 + 3 weeks). 34% had an equivocal diagnosis. Counselling on outcomes varied across units. Spontaneous preterm birth occurred in 41% of cases with a further 18% being delivered preterm for suspected chorioamnionitis. All units used maternal heart rate, temperature, C-reactive protein and white cell count to monitor for infection although neither absolute values at delivery nor trends in any of these were predictive of histological chorioamnionitis. Most women felt that their outpatient care was acceptable, but highlighted deficiencies in emotional support offered.

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