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Expectant Management of Midtrimester Premature Rupture of Membranes: A Plea for Limits

Abstract

OBJECTIVE: Our aim was to assess neonatal and maternal complications of the expectant management of pregnancies with preterm premature rupture of membranes (P-PROM) prior to 24 weeks of gestation and to delineate a patient consult strategy.

STUDY DESIGN: We included all consecutive cases of early midtrimester P-PROM (16–24 weeks gestation). Information coded in our perinatal database was analyzed. Descriptive statistics, Student's t-test and Mann–Whitney test, and a logistic regression model were built accordingly.

RESULTS: A total of 28 women presented with P-PROM at 16–24 weeks (mean 22.7±1.0 weeks). Two patients declined conservative management and one was lost to follow-up (10.7%). In all, 25 (89.2%) were followed until the onset of labor or development of chorioamnionitis. Overall, 8/25 (32%) Of the neonates survived. Pulmonary hypoplasia accounted for three deaths (3/25, 12%). Of 10 pregnancies with P-PROM before 22 weeks gestation, two (20%) neonates survived. The amount of amniotic fluid and gestational age at the time of diagnosis were crucial independent factors determining overall survival. Pulmonary hypoplasia (12%) and skeletal deformities (0%) were infrequent. The 21-day mean maternal antenatal hospital stay was further complicated by a high cesarean rate delivery (33.7%) and by postpartum infectious morbidity (32%).

CONCLUSION: In cases of early midtrimester P-PROM (<24 weeks) expectantly managed, neonatal survival is positively associated with the amount of amniotic fluid present and with the gestational age at the time of diagnosis. The mothers are at increased risk of prolonged antenatal hospitalization, cesarean delivery, preterm birth, and postpartum infection. In very early midtrimester P-PROM (<22 weeks), the maternal complication rate outweighs the poor neonatal outcome and expectant management should be reconsidered.

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References

  1. Mercer B . Management of premature rupture of membranes before 26 weeks' gestation. Obstet Gynecol Clin N Am 1992;19(2):338–351.

    Google Scholar 

  2. Morales WJ, Talley T . Premature rupture of membranes at &lt;25 weeks: A management dilemma. Am J Obstet Gynecol 1993;168:503–507.

    Article  CAS  Google Scholar 

  3. Williams . Obstetrics 21st ed. Section VII; Common Complications of Pregnancy. Preterm Birth, Chapter 27. New York: McGraw-Hill Medical Publishing Division; 2001. p. 689–729.

  4. Moore TR, Cayle JE . The amniotic fluid index in normal human pregnancy. Am J Obstet Gynecol 1990;162:1168–1173.

    Article  CAS  Google Scholar 

  5. Leonidas JC, Bhan I, Beatty EC . Radiographic chest contour and pulmonary air leak in oligohydramnios and related pulmonary hypoplasia (Potter's syndrome). Invest Radiol 1982;17:6–10.

    Article  CAS  Google Scholar 

  6. Vergani P, Ghidini A, Locatelli A, et al. Risk factors for pulmonary hypoplasia in second trimester premature rupture of membranes. Am J Obstet Gynecol 1994;170:1359–1364.

    Article  CAS  Google Scholar 

  7. Rotchild A, Ling EW, Puterman ML, Farquharson D . Neonatal outcome after prolonged premature rupture of membranes. Am J Obstet Gynecol 1990;162:46–52.

    Article  Google Scholar 

  8. Thibeault DW, Beatty EC, Hall RT, Bowen SK, O'Neill DH . Neonatal pulmonary hypoplasia with premature rupture of fetal membranes and oligohydramnios. J Pediatr 1985;107(2):273–277.

    Article  CAS  Google Scholar 

  9. Bedouyn S, Yasin S . Premature rupture of membranes before 28 weeks : Conservative management. Obstet Gynecol 1986;155:471–479.

    Google Scholar 

  10. Blott M, Greennough A . Neonatal outcome after prolonged rupture of the membranes starting in the second trimester. Arch Dis Childhood 1988;63:1146–1150.

    Article  CAS  Google Scholar 

  11. Bengtson JM, Van Marter LJ, Brass VA, Greeene MF, Tuomala RF, Epstein MF . Pregnancy outcome after premature rupture of the membranes at or before 26 weeks gestation. Obstet Gynecol 1989;73(6):921–927.

    CAS  PubMed  Google Scholar 

  12. Major CA, Kitzmiller JL . Perinatal survival with expectant management of midtrimester rupture of membranes. Am J Obstet Gynecol 1990;163(3):838–844.

    Article  CAS  Google Scholar 

  13. Hadi HA, Hodson CA, Strickland D . Premature rupture of membranes between 20–25 weeks gestation: Role of amniotic fluid volume in perinatal outcome. Am J Obstet Gynecol 1994;170(4):1139–1144.

    Article  CAS  Google Scholar 

  14. Kilbride HW, Yeast J, Thibeault DW . Defining limits of survival: Lethal pulmonary hypoplasia after mid-trimester premature rupture of membranes. Am J Obstet Gynecol 1996;175:675–681.

    Article  CAS  Google Scholar 

  15. Winn HN, Chen M, Amon E, Leet TL, Shumway JB, Mostello D . Neonatal pulmonary hypoplasia and perinatal mortality in patients with mid-trimester rupture of amniotic membranes – A critical analysis. Am J Obstet Gynecol 2000;182(6):1638–1644.

    Article  CAS  Google Scholar 

  16. Schuker JL, Mercer BM . Midtrimester premature of the membranes. Semin Perinatol 1996;20(5):389–400.

    Article  Google Scholar 

  17. Wenstrom KD . Pulmonary hypoplasia and deformations related to premature rupture of membranes. Obstet Gynecol Clin North Am 1992;19(2):297–408.

    Google Scholar 

  18. Hoekstra JH, deBoer R . Very early prolonged premature rupture of the membranes and survival. Eur J Pediatr 1990;149:585–586.

    Article  CAS  Google Scholar 

  19. Shumway JB, Al-Malt A, Cohlan B, Amini S, Abboud M, Winn HN . Impact of oligohydramnios on maternal and perinatal outcomes of spontaneous premature rupture of membranes at 18–28 weeks. J Matern Fetal Med 1999;8:20–23.

    CAS  PubMed  Google Scholar 

  20. Lindner W, Pohland F, Grab D, Flock F . Acute respiratory failure and short term outcome after premature rupture of the membranes and oligohydramnios before 20 weeks gestation. J Pediatr 2002;140(2):177–182.

    Article  Google Scholar 

  21. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR . Neurologic and developmental disability after extremely preterm birth. New Engl J Med 2000;343(6):378–384.

    Article  CAS  Google Scholar 

  22. Campbell DE, Fleishman AR . Limits of viability: Dilemmas, decisions, and decision makers. Am J Perinatol 2001;18(3):117–128.

    Article  CAS  Google Scholar 

  23. Saigal S . The limits of viability – A review for the EPICure Study Group 2000. Pediatr Res 2001;49(4):451.

    Article  CAS  Google Scholar 

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Grisaru-Granovsky, S., Eitan, R., Kaplan, M. et al. Expectant Management of Midtrimester Premature Rupture of Membranes: A Plea for Limits. J Perinatol 23, 235–239 (2003). https://doi.org/10.1038/sj.jp.7210880

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