预防胎膜灶破的现代管理（英文PPT）ModernManagement of Prolonged Rupture of .ppt

Antibiotics PPROM: Summary No clear reduction in perinatal death No clear reduction in cerebral abnormalities Kenyon, Cochrane Library, 1999 Amniocentesis PPROMAmniotic Fluid Culture Group B Streptococcus 20 % Gardnerella vaginalis 17 % Peptostreptococcus 11 % Fusobacteria 10 % Bacteroides fragilis 9 % Other Streptococci 9 % Bacteroides sp. 5 % Utility of Amniocentesis Confirm/Refute diagnosis of chorioamnionitis Glucose 15 mg/dL Culture Gram stain Lung maturity testing Corticosteroids Corticosteroids for FLM Betamethasone Dexamethasone PPROMCorticosteroids Block Taeusch Papageorgiou Young Garite Collaborative Iams Nelson Simpson Morales 43 17 17 38 80 153 38 22 112 121 26 24 19 37 80 135 35 46 105 124 Author Steroids Control Effect on RDS Number of Patients PPROMCorticosteroids Crowley, Ob/Gyn Clinics, 1992 * PPROMCorticosteroids + Antibiotics * Lewis, Obstetrics Gynecology, 1996 1994 NIH Consensus Conference:Corticosteroids in PPROM Corticosteroids reduce incidence/severity of RDS, IVH Benefits in PPROM up to 30-32 weeks No significant adverse outcomes for corticosteroid use in PPROM Impact less than with intact membranes Observation vs. Induction Neonatal Morbidity/MortalityUAB (1995-1996) % PPROMObservation vs. Induction Mercer, AJOG, 1993 * * PPROMObservation vs Induction Cox, Obstetrics Gynecology, 1995 Fetal Lung Maturity Testing Fetal Lung MaturationBiologic Markers 8 6 4 2 0 0 4 2 6 8 20 24 28 32 36 40 Gestational Age (weeks) L:S Ratio % Phospholipid L:S PI PG 10 Fetal Lung Maturity Evaluation in Vaginal Pool Specimen L:S Ratio Not Reliable TDX:FLM Assay Not Validated PG Useful Fetal Surveillance PPROMFetal Surveillance Daily Non-Stress Test (NST) Variables Tachycardia Loss of reactivity Biophysical Profile (BPP) Contraction Stress Test (CST) Summary UAB Management of PPROM PPROM ?34 weeks Deliver Previable PROM Outpatient observation Antibiotic prophylaxis Option of termination 22wk Admission at viabilit