Expectant management of midtrimester premature rupture of membranes: a plea for limits.
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.


METHODS
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%).


CONCLUSIONS
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.
Department of Obstetrics and Gynecology, Shaare Zedeck Medical Center, Jerusalem, Israel.
Sorina
S
Grisaru-Granovsky
Rami
R
Eitan
Michael
M
Kaplan
Arnon
A
Samueloff
D000328:Adult; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies