Active expectant management in very early gestations complicated by premature rupture of the fetal membranes.
Premature rupture of the membranes (PROM) in the previable gestation is frequently associated with fetal or neonatal death. Passive expectant management is successful in only a small minority of cases. Women presenting with PROM at < or = 27 weeks' gestation were treated with tocolysis and prophylactic antibiotics and delivered electively for lung maturity. The corrected perinatal survival was > 92%. The mean latency phase was 21.6 days (+/- 18.12 SD). Twenty-one percent of patients presented in labor; the mean latency phase for this subgroup was 14.4 (+/- 8.54) days. Nineteen patients (79%) had a latency phase > 7 days, and 14 (58%) had a latency phase > 14 days. Thirty-nine percent of infants required < 48 hours of mechanical ventilation. Six infants were delivered with intraventricular hemorrhage; in all cases it was grade 1 or 2. There were three (12.5%) postpartum infections and three septic neonates. Active expectant management using tocolysis and prophylactic antibiotics was associated with a prolonged latency phase, low infectious morbidity and good neonatal outcome.
Fortunato
S J
SJ
Department of Obstetrics and Gynecology, Wright State University, Dayton, Ohio.
Welt
S I
SI
Eggleston
M K
MK
Bryant
E C
EC
D000328:Adult; D015296:Ceftizoxime / Q000627:therapeutic use*; D002985:Clinical Protocols; D003663:Decision Trees; D036861:Delivery, Obstetric / Q000379:methods*; D004359:Drug Therapy, Combination; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D005323:Fetal Monitoring; D005325:Fetal Organ Maturity; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D013726:Terbutaline / Q000627:therapeutic use*
D008278:Magnesium Sulfate; D015296:Ceftizoxime; D013726:Terbutaline