Preterm prematür membran rüptürü olgularında spontan ve indüklenmiş eylemin maternal ve fetal sonuçlara etkisi

Öz

Amaç: Bu çalışmamızda preterm prematür membran rüptürü (PPROM) ile komplike

gebeliklerde spontan travaya giren olgularla çeşitli endikasyonlarla doğum indüksiyonu yapılan

olguların perinatal sonuçlarını ve latent sürenin bu sonuçlara etkisini araştırmayı amaçladık.

Materyel-metod: Ocak 2014-Ocak 2016 yılları arasında kliniğimizde 24-34 gebelik haftalar

arasındaki PPROM tanısı alan gebelerin perinatal sonuçları retrospektif olarak değerlendirildi.

Bulgular: Çalışmaya 93 olgu dahil edildi ve 43 olguda (%46) doğum eylemi takip sırasında

spontan başladı (Grup 1), 50 olguda (%54) ise doğum eylemi indüksiyonla başlatıldı (Grup 2).

PPROM oluşan zamandan doğuma kadar geçen süre grup 1’de 5.8±2.1 gün, grup 2’de 8.3±3.5

gündü (p:0,19). Ortalama doğum haftası grup 1’de 30.4±2.3 hafta iken grup 2’de 30.5±2.5

haftaydı (p: 0.91). Doğum ağırlıkları arasında anlamlı fark saptanmadı. Grup 1’de 19 (%44.1)

olgu sezaryen ile doğum yaptı, grup 2’de ise 37 (%74) olguda sezaryen ihtiyacı görüldü

(p:0.03). Grup 1’de 4 (%9.3), grup2’de 3 (%6) olguda YDYBÜ takibi sırasında exitus

gerçekleşti (p: 0.54). Grup 1’de 14 (%32.5) grup 2’de ise 17 (%34) olguda ciddi morbidite

geliştiği görüldü. Mortalite ve ciddi morbidite üzerine latent sürenin anlamlı etkisi görülmedi

(p:0.54, p:0.67)

Sonuç: PPROM olgularında latent sürenin neonatal sonuçlara anlamlı etkisi gösterilmemiştir

ve maternal veya fetal iyilik hali güven verdiği sürece ekspektan yaklaşım uygun takip

yöntemidir.

Anahtar Kelimeler

• eylem,erken doğum

The influence of spontaneous and induced labor in maternal and fetal outcomes in preterm prematüre rupture of membranes

Abstract

Aim: We evaluated the effect of spontaneous and induced parturition in maternal and fetal

outcomes in preterm prematüre rupture of membranes (PPROM) and analyzed the influence of

the latent period in these results.

Materials-method: We analyzed the results of patients who were complicated with PPROM in

24-34 weeks of gestation between January 2014-January 2016 in our clinic.

Results: We collected 93 cases and in 43 patients (46%) the labor occurs spontaneously (Group

1) and in 50 cases (54%) we induced the labor due to maternal and fetal indications (Group 2).

The interval between when PPROM occurred, and labor was 5.8±2.1 days in group 1 and

8.3±3.5 days in group 2 (p:0,19). There was no significant difference between birthweights in

two groups. C-section was performed in 19 (%44.1) patients in group 1 and 37 (%74) cases

were delivered by C-section in group 2 (p: 0.03). Neonatal mortality was 9.3% in group 1 and

6% in group 2 (p:0.54). Severe morbidity was detected in 14 (%32.5) patients in group 1 and

17 (%34)in group 2. We did not show a significant effect of latency period into the severe

morbidity and mortality in newborns (p:0.54, p:0.67).

Conclusion: There was no relevant effect of latency period into the neonatal outcomes, and

expectant management should be used in PPROM cases if the maternal and fetal status is

reassuring.

Keywords

• newborn,parturition

Kaynakça

1. 1. Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol 2003;101(1): 178-932. Creasy RK. Preterm birth prevention: where are we? A m J Obstet Gynecol 1993;168:1223-303. Mathews TJ, MacDorman MF. İnfant mortality statistics from the 2005 period linked birht/infant death data set. Natl Vital Stat Rep 2008 ;57:14. Asrat T, Lewis DF, Garite TJ, et al. Rate of recurrence of Preterm Pemature Rupture of Membranes in consecutive pregnancies. Am J Obstet Gynecol 1991; 165:1111-11155. Scott JR, Disaina J, Hammond CB, Spellacy WN. Danforth's Obstetrics andGynecology. 1994; Seventh Edition:305-3166. Harger JH, Hsing AW, Tuomala RE, Gibbs RS, Mead PB, Eschenbach DA, et al. Risk factors for preterm premature rupture of fetal membranes: a multicenter case-control study. Am J Obstet Gynecol 1990;163(1 Pt 1):130- 7.7. Mercer BM, Goldenberg RL, Moawad AH et al. The preterm prediction study: Effect of gestational age and cause of preterm birth on subsequent obstetric outcome. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 1999; 181:12168. Kenyon S, Pike K, Jones DR, et al. Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of membranes: 7 year-follow up the ORACLE I trial. Lancet 2008; 372:13109. ACOG Practice Bulletin No. 139: Premature rupture of membranes. Clinical management guidelines for obstetrician gynecologists. Obstet Gynecol 2013;122(4):918-3010. Royal College of Obstetricians and Gynaecologists. Greentop Guideline No. 44: Preterm Prelabour Rupture of Membranes. London: RCOG; 2010.11. J.-C. Pasquier et al. Neonatal outcomes after elective delivery management of preterm premature rupture of the membranes before 34 weeks’ gestation (DOMINOS study) Eu J Obstet Gynecol and Reprod Bio 143 (2009) 18–23.12. Parry S, Strauss JF: Premature rupture of the fetal membranes. N Engl J Med. 1998; 338:663-670 Yoon BH, Romero R, Moon JB, et al. Clinical significance of intra-amniotic inflammation in patients with preterm labor and intact membranes. Am J Obstet Gynecol 2001; 185:1130.13. Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes Cochrane Database Syst Rev 2013;(12):CD001058.14. Gunn GC, Mishell DR, Morton DG: Premature rupture of the fetal membranes: a review. Am J Obstet Gynecol. 1970; 106:469-48215. Themistoklis Dagklis, Stamatios Petousis, Chrysoula Margioula-Siarkou, George Mavromatidis, Ioannis, Kalogiannidis, Nikos Prapas, Apostolos Mamopoulos, and David Rousso. Parameters affecting latency period in PPROM cases: a 10-year experience of a single institution. J Matern Fetal Neonatal Med, 2013; 26(14): 1455–145816. Waters TP, Mercer BM. The management of preterm prematüre rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol 2009;201:230–4017. Priscilla Frenette, Linda Dodds, B. Anthony Armson, Krista Jangaard. Preterm Prelabour Rupture of Membranes: Effect of Latency on Neonatal and Maternal Outcomes. J Obstet Gynaecol Can 2013;35(8):710–71718. Major CA, de Veciana M, Lewis DF, Morgan MA. Preterm premature rupture of membranes and abruptio placentae: is there an association between these pregnancy complications? Am J Obstet Gynecol 1995;172:67219. Ananth CV, Oyelese Y, Srinivas N, Yeo L, Vintzileos AM. Preterm premature rupture of membranes, intrauterine infection, and oligohydramnios: risk factors for placental abruption. Obstet Gynecol 2004;104:71–7520. Behbehani S, Patenaude V, Abenhaim HA. Maternal Risk Factors and Outcomes of Umbilical Cord Prolapse: A Population-Based Study. J Obstet Gynaecol Can 2016; 38:23.21. J. M. Bendix, H. K. Hegaard, T. Bergholt , J. Langhoff-Roos. Expectant management of PPROM and major complications before planned delivery: A retrospective cohort study. Journal of Obstetrics and Gynaecology, 2015;35:570-57722. Matthews TJ, MacDorman MF, Thoma ME. Infant Mortality Statistics From the 2013 Period Linked Birth/Infant Death Data Set. Natl Vital Stat Rep 2015; 64:1.23. Spinillo A, Capuzzo E, Stronati M, Ometto A, Orcesi S,Fazzi E. Effect of preterm premature rupture of membraneson neurodevelopmental outcome: follow up at two years of age. Br J Obstet Gynaecol 1995;102:88224. Locatelli A, Ghidini A, Paterlini G, et al. Gestational age at preterm premature rupture of membranes: a risk factor for neonatal whitematter damage. Am J Obstet Gynecol 2005;193:947–51.25. Buchanan SL, Crowther CA, Levett KM, Middleton P,Morris J. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks’ gestation for improving pregnancy outcome. Cochrane Database of Systematic Reviews 2010, 17;(3)26. Hazem Al-Mandeel, Mohammed Y, Alhindi Reg Sauve. Effects of intentional delivery on maternal and neonatal outcomes in pregnancies with preterm prelabour rupture of membranes between 28 and 34 weeks of gestation: a systematic review and meta-analysis. The Journal of Maternal-Fetal and Neonatal Medicine, 2013; 26(1): 83–8927. J.C. Pasquier et al. Neonatal outcomes after elective delivery management of preterm premature rupture of the membranes before 34 weeks’ gestation (DOMINOS study) Eur J Obstet Gynecol and Reprod Bio 143 (2009) 18–23