The Effect Of Expectant Treatment On The Pregnancy Outcome Of Preterm Prelabor Rupture Of Membranes

Objective:To compare the pregnancy outcomes of PPROM patients among different gestational age groups,and to analyze the effect of expectant time on the pregnancy outcome of PPROM patients,strengthen the management of PPROM patients to improve the maternal and neonatal outcomes and reduce the incidence rate and mortality of perinatal neonates.Methods:From November 2013 to October 2018,192 cases with PPROM were selected,who were hospitalized and delivered in Qilu Hospital of Shandong University and met the inclusion and exclusion criteria.According to the gestational weeks of PPROM,subjects were divided into four groups:24～27+6 weeks of gestation(group A),28～31+6 weeks of gestation(group B),32～33+6 weeks of gestation(Group C),34～36+6 weeks of gestation(Group D).In each gestational weeks,according to the time of expected treatment,it is divided into three groups:expected treatment time ≥3 days～≤ 7days;expected treatment time≥ 8 days～≤ 14 days;expect treatment time>14 days.The pregnancy outcome and delivery mode were compared.The pregnancy outcome and delivery mode were compared among the groups.Results:1.There was no significant difference in age and delivery mode of PPROM patients in different gestational weeks.There was significant difference in delivery gestational age(P<0.001).Patients with small gestational weeks had long average expectant treatment time,but there was no significant difference in expectant treatment time between groups B and C and between groups C and D(P>0.05).2.Comparison of maternal outcomes of PPROM in different gestational weeks:There was no significant difference in placental abruption,postpartum hemorrhage and chorioamnionitis among the four groups(P>0.05).There was significant difference in umbilical cord prolapse and fetal distress(P<0.05).Compared with group C and group D,the incidence of cord prolapse in group A was significantly higher,and compared with group D,the incidence of fetal distress in group A and group B was significantly increased.3.Comparison of PPROM neonatal outcomes in different gestational age groups:With the increase of gestational weeks,the Apgar score was improved,the proportion of transferring to NICU and the days of hospitalization of NICU decreased,the incidence of adverse neonatal outcomes(such as NRDS,neonatal infection,bronchopulmonary dysplasia,premature encephalopathy)and perinatal death decreased(P<0.05).4.Comparison of maternal outcomes of PPROM in different expectant treatment time:There was no significant difference in adverse outcome of parturient such as placental abruption,umbilical cord prolapse,fetal distress,postpartum hemorrhage,chorioamnionitis,etc.(P>0.05).In the patients of 28-32 weeks of gestation,the prolonged expectant treatment time increased the cesarean section rate(P<0.05).5.Effects of different expectant treatment time on neonatal outcome:In the patients of<28 weeks of gestation,the incidence of neonatal asphyxia,neonatal complications and perinatal death in patients with expectant treatment time>14 days is lower,but differences were not statistically significant(P>0.05).In the patients of 28～32 weeks of gestation,with the prolongation of expectant treatment time,the incidence of neonatal asphyxia and NRDS decreased and the average weight of neonates increased(P<0.05);the neonatal infection,BPD and encephalopathy in the expectant treatment time>14 days group was lower than that in the other groups,but the difference was not statistically significant(P>0.05).In the patients of 32～34 weeks of gestation,there was no significant relationship between the expectant treatment time and the neonatal outcome.5.In the patients of 34～37 weeks of gestation,with the prolongation of expectant time,the hospitalization rate of NICU decreased,and there was no significant relationship between the neonatal outcome and the length of expectant time.Conclusions:1.Under close monitoring,the prolongation of expectant treatment time did not increase the incidence of chorioamnionitis,postpartum hemorrhage,placental abruption,umbilical cord prolapse and fetal distress.2.Expectant treatment can improve the neonatal outcome of PPROM patients less than 32 weeks of gestational.3.The smaller the gestational age,the longer the average expectant treatment time.The prolongation of expectant treatment time increased the cesarean section rate of PPROM patients in the patients of 28～32 weeks of gestational.