title: Active expectant management in very early gestations complicated by premature rupture of the fetal membranes.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Wright State University, Dayton, Ohio.
authors.forename: S J
authors.initials: SJ
authors.lastname: Fortunato
authors.forename: S I
authors.initials: SI
authors.lastname: Welt
authors.forename: M K
authors.initials: MK
authors.lastname: Eggleston
authors.forename: E C
authors.initials: EC
authors.lastname: Bryant
mesh_terms: 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*
chemical_list: D008278:Magnesium Sulfate; D015296:Ceftizoxime; D013726:Terbutaline