PRETERM MEMBRAN RÜPTÜRÜ (PPROM) YÖNETİMİNDE GÜNCEL YAKLAŞIMLAR
Özet
PPROM, 37. haftadan önce, travay başlamadan membranların açılmasıdır; gebeliklerin %2–3'ünü, spontan preterm doğumların üçte birini oluşturur.
Risk faktörleri: Önceki PPROM/preterm doğum öyküsü, kısa serviks, vajinal kanama, alt genital enfeksiyonlar, invaziv girişimler (amniyosentez, serklaj), sigara, düşük VKİ, çoğul gebelik/polihidramniyoz.
Tanı: Steril spekulum muayenesi temel yöntemdir (vajinal tuşe kaçınılmalı). Sıvı gözlenmezse nitrazin/ferning; belirsiz olgularda IGFBP-1/PAMG-1 testleri. İntraamniyotik enfeksiyon tanısı: tek ölçümde ≥39°C ateş VEYA 38–38,9°C ateşe lökositoz/pürülan akıntı/fetal taşikardiden birinin eşlik etmesiyle konur (maternal/fetal taşikardi ve uterin hassasiyet artık tek başına tanı koydurucu değil).
Gestasyonel yaşa göre yönetim: 22. haftanın altında yönlendirici olmayan danışmanlık esastır; steroid, tokoliz, MgSO₄ ve antibiyoterapi rutin uygulanmaz. 22 0/7–23 6/7 haftada karar bireyselleştirilir, merkezin yenidoğan kapasitesine göre steroid ve MgSO₄ değerlendirilebilir. 24 0/7–33 6/7 hafta arası standart beklemeli yönetim dönemidir: hastane yatışı, tek kür antenatal steroid, 48 saatlik latent dönem antibiyoterapi,
Anahtar Kelimeler: reterm prematür membran rüptürü (PPROM), Antenatal kortikosteroid, Magnezyum sülfat nöroproteksiyonu, Koriyoamniyonit, Geç preterm doğum
Konu Alanı: Tıp -> Tıp (diğer) -> Kadın Hastalıkları ve Doğum
American College of Obstetricians and Gynecologists. (2017a). Intrapartum management of intraamniotic infection: ACOG Committee Opinion No. 712. Obstetrics & Gynecology, 130(2), e95–e101. https://doi.org/10.1097/AOG.0000000000002236
American College of Obstetricians and Gynecologists. (2017b). Periviable birth: Obstetric Care Consensus No. 6. Obstetrics & Gynecology, 130(4), e187–e199. https://doi.org/10.1097/AOG.0000000000002352
American College of Obstetricians and Gynecologists. (2020). Prelabor rupture of membranes: ACOG Practice Bulletin No. 217. Obstetrics & Gynecology, 135(3), e80–e97. https://doi.org/10.1097/AOG.0000000000003700
American College of Obstetricians and Gynecologists. (2024). Update on criteria for suspected diagnosis of intraamniotic infection: ACOG Clinical Practice Update. Obstetrics & Gynecology, 144(1), e17–e19. https://doi.org/10.1097/AOG.0000000000005593
American College of Obstetricians and Gynecologists. (2025, Mayıs). Increased risk of maternal morbidity associated with previable and periviable preterm prelabor rupture of membranes [Practice Advisory]. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2025/05/increased-risk-of-maternal-morbidity-associated-with-previable-and-periviable-preterm-prelabor-rupture-of-membranes
Battarbee, A. N., Osmundson, S. S., McCarthy, A. M., & Louis, J. M. (2024). Society for Maternal-Fetal Medicine Consult Series #71: Management of previable and periviable preterm prelabor rupture of membranes. American Journal of Obstetrics and Gynecology, 231(4), B2–B15. https://doi.org/10.1016/j.ajog.2024.07.016
Bond, D. M., Middleton, P., Levett, K. M., van der Ham, D. P., Crowther, C. A., Buchanan, S. L., & Morris, J. (2017). 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, 2017(3), Article CD004735. https://doi.org/10.1002/14651858.CD004735.pub4
Gyamfi-Bannerman, C., Thom, E. A., Blackwell, S. C., Tita, A. T. N., Reddy, U. M., Saade, G. R., ve ark. (2016). Antenatal betamethasone for women at risk for late preterm delivery. New England Journal of Medicine, 374(14), 1311–1320. https://doi.org/10.1056/NEJMoa1516783
Kenyon, S. L., Taylor, D. J., & Tarnow-Mordi, W., ORACLE Collaborative Group. (2001). Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: The ORACLE I randomised trial. The Lancet, 357(9261), 979–988. https://doi.org/10.1016/S0140-6736(00)04233-1
Martingano, D., Singh, S., & Mitrofanova, A. (2020). Azithromycin in the treatment of preterm prelabor rupture of membranes demonstrates a lower risk of chorioamnionitis and postpartum endometritis with an equivalent latency period compared with erythromycin antibiotic regimens. Infectious Diseases in Obstetrics and Gynecology, 2020, Article 2093530. https://doi.org/10.1155/2020/2093530
Morris, J. M., Roberts, C. L., Bowen, J. R., Patterson, J. A., Bond, D. M., Algert, C. S., Thornton, J. G., & Crowther, C. A., PPROMT Collaboration. (2016). Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): A randomised controlled trial. The Lancet, 387(10017), 444–452. https://doi.org/10.1016/S0140-6736(15)00724-2
Reddy, U. M., Deshmukh, U., Dude, A., Harper, L., & Osmundson, S. S., Society for Maternal-Fetal Medicine (SMFM). (2021). Society for Maternal-Fetal Medicine Consult Series #58: Use of antenatal corticosteroids for individuals at risk for late preterm delivery. American Journal of Obstetrics and Gynecology, 225(5), B36–B42. https://doi.org/10.1016/j.ajog.2021.07.023
Ronzoni, S., Boucoiran, I., Yudin, M. H., Coolen, J., Pylypjuk, C., Melamed, N., ve ark. (2022). Guideline No. 430: Diagnosis and management of preterm prelabour rupture of membranes. Journal of Obstetrics and Gynaecology Canada, 44(11), 1193–1208.e1. https://doi.org/10.1016/j.jogc.2022.08.014
Seaman, R. D., Kopkin, R. H., & Turrentine, M. A. (2022). Erythromycin vs azithromycin for treatment of preterm prelabor rupture of membranes: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 226(6), 794–801.e1. https://doi.org/10.1016/j.ajog.2021.12.262
Shepherd, E. S., Goldsmith, S., Doyle, L. W., Middleton, P., Marret, S., Rouse, D. J., Pryde, P., Wolf, H. T., & Crowther, C. A. (2024). Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database of Systematic Reviews, 2024(5), Article CD004661. https://doi.org/10.1002/14651858.CD004661.pub4
Sklar, A., Sheeder, J., Davis, A. R., Wilson, C., & Teal, S. B. (2022). Maternal morbidity after preterm premature rupture of membranes at <24 weeks' gestation. American Journal of Obstetrics and Gynecology, 226(4), 558.e1–558.e11. https://doi.org/10.1016/j.ajog.2021.10.036
Thomson, A. J., & Royal College of Obstetricians and Gynaecologists. (2019). Care of women presenting with suspected preterm prelabour rupture of membranes from 24+0 weeks of gestation: Green-top Guideline No. 73. BJOG: An International Journal of Obstetrics & Gynaecology, 126(9), e152–e166. https://doi.org/10.1111/1471-0528.15803
Wojcieszek, A. M., Stock, O. M., & Flenady, V. (2014). Antibiotics for prelabour rupture of membranes at or near term. Cochrane Database of Systematic Reviews, 2014(10), Article CD001807. https://doi.org/10.1002/14651858.CD001807.pub2
ELLİBEŞ KAYA, A. & ali, c. (2026). PRETERM MEMBRAN RÜPTÜRÜ (PPROM) YÖNETİMİNDE GÜNCEL YAKLAŞIMLAR. In YURTCU, N. (Ed.), Obstetrik ve Jinekolojik Acillerde Multidisipliner Güncel Yaklaşım (pp. 348-361). Vizetek Yayıncılık. https://doi.org/10.54637/vizetek.9786253823962
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