Outcomes with premature rupture of membranes at 32 or 33 weeks when management is based on evaluation of fetal lung maturity.
OBJECTIVE
To assess outcomes of patients with premature rupture of membranes (PROM) at 32 or 33 weeks gestation.


METHODS
This historical cohort study included all immune competent patients managed at our institution from October 1, 1999 to March 31, 2003 with singleton gestations and PROM at 32 or 33 weeks, and without clinical chorioamnionitis at presentation or antenatal diagnosis of a fetal anomaly. If amniotic fluid studies revealed pulmonary maturity, patients were intentionally delivered. Otherwise, they were expectantly managed until intentional delivery at 34 weeks, or labor, chorioamnionitis, or non -reassuring testing led to delivery sooner.


RESULTS
For the groups with mature (n = 29) and immature or unobtainable (n = 60) fluid, respectively, rates of neonatal ICU admission (83% vs. 77%; p = 0.51), respiratory distress (41% vs. 45%; p = 0.75), mechanical ventilation (10% vs. 17%; p = 0.53), and proven neonatal infection (4% vs. 2%; p = 0.60) were similar, as were rates of other neonatal and maternal complications. The mature group had shorter mean maternal hospital stays (3.6 +/- 0.6 vs. 6.4 +/- 2.9 d; p < 0.001) and latency periods (30.2 +/- 19.3 vs. 83.8 +/- 68.7 h; p < 0.001).


CONCLUSIONS
Compared to those managed expectantly due to immature or unavailable fetal lung studies, intentional delivery of patients with PROM at 32 or 33 weeks with mature fetal lung studies did not increase neonatal morbidity in our small cohort.
Edwards
Rodney
R
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Florida College of Medicine, PO Box 100294, Gainesville, FL 32610, USA.
Stickler
Laura
L
Johnson
Isaiah
I
Duff
Patrick
P
D000328:Adult; D000465:Algorithms; D000653:Amniotic Fluid / Q000737:chemistry*; D015331:Cohort Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D005325:Fetal Organ Maturity; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000379:methods; D008168:Lung / Q000196:embryology*; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011296:Prenatal Diagnosis; D012189:Retrospective Studies