Perinatal outcome following conservative management of mid-trimester pre-labour rupture of the membranes.
OBJECTIVE
To assess perinatal outcome and the effect of antenatal steroid use following conservative management of 86 consecutive singleton pregnancies complicated by pre-labour rupture of membranes (ROM) in the mid-trimester (13-26 weeks; mean 22.8 weeks).


METHODS
Review of obstetric and neonatal case notes between 1 January 1990 and 31 December 1993.


RESULTS
The duration of ruptured membranes (latent period) ranged from 1.25 to 105 days (mean 23.8 days; median 14 days) and was inversely related to gestational age at ROM. There was clinical evidence of chorioamnionitis in 39.5% with placental histological changes consistent with chorioamnionitis in 76.6%. All infants were delivered before 33 weeks gestation (mean 26 weeks). Overall, the mortality rate was 43.0% but 62.5% in infants with ROM before 24 completed weeks gestation. Adverse outcome (defined as death, severe intraventricular haemorrhage (IVH) or periventricular leucomalacia (PVL)) occurred in 46.5% and was significantly related to both gestation at delivery and gestation at ROM. In the group (n = 40) with ROM before 24 weeks gestation, adverse outcome occurred in 65% and was inversely related to gestation at ROM independent of gestation at delivery. Antenatal steroid administration resulted in less adverse outcome independent of gestation at delivery (OR 0.31; 95% CI (0.09-0.98; P = 0.046)).


CONCLUSIONS
From the neonatal perspective conservative management is justified for pregnancies with ROM at or after 24 weeks gestation; in this group the use of antenatal steroids prior to delivery may improve perinatal outcome. A poor outcome is associated with ROM that occurs before 24 weeks gestation.
Nourse
C B
CB
Department of Neonatology, Mater Mothers' Hospital, Annerley, Queensland, Australia.
Steer
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PA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000453:epidemiology / Q000209:etiology; D016017:Odds Ratio; D018743:Perinatal Care / Q000379:methods / Q000592:standards*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011793:Queensland / Q000453:epidemiology; D012044:Regression Analysis; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use*; D015145:Tocolysis / Q000592:standards*
D013256:Steroids