title: Expectant management of preterm premature rupture of membranes and nonvertex presentation: what are the risks?
abstract: OBJECTIVE
  Preterm premature rupture of membranes (PPROM) continues to be a major cause of preterm births. The objective of this study was to compare the morbidity of patients with PPROM nonvertex presentations with patients with PPROM with vertex presentations.
  
  
  METHODS
  A retrospective analysis of data from 74 patients with PPROM with nonvertex presentations (study group) and 74 patients with PPROM with vertex presentations (control group) comprised the 2 study groups. All patients that met the study admission criteria were treated in a similar manner at 1 of 3 level-III hospitals. The gestational ages at delivery of all patients were between 23-34 weeks, and the gestational ages between case and control patients were matched for gestational age.
  
  
  RESULTS
  A statistically significant (P = .03) higher incidence of a prolapsed umbilical cord was found in the study group (n = 8; 10.8%) relative to the control group (n = 1; 1.4%). More infants in the study group had low 5-minute Apgar scores (<5) and/or low cord pH (<7.20; n = 25 [33.8%]) than in the control group (n = 12 [16.2%]; P = .02). Five infants with breech presentations underwent a precipitous unplanned vaginal delivery. Significant morbidity was not detected in these 5 infants.
  
  
  CONCLUSIONS
  After transfer to an antenatal ward, patients with PPROM with nonvertex presentations appear to have a significantly higher risk for prolapsed umbilical cords, lower Apgar scores, and/or lower umbilical cord blood pH values, when compared with their vertex counterparts. Additionally, there appears to be substantial risk of an unintended, vaginal breech delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, LA 71130-3932, USA. DLewi1@Lsuhsc.edu
authors.forename: David F
authors.initials: DF
authors.lastname: Lewis
authors.forename: Alfred G
authors.initials: AG
authors.lastname: Robichaux
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Jaekle
authors.forename: Amber
authors.initials: A
authors.lastname: Salas
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Canzoneri
authors.forename: Kelly
authors.initials: K
authors.lastname: Horton
authors.forename: Lauren
authors.initials: L
authors.lastname: Jaekle
authors.forename: Charles
authors.initials: C
authors.lastname: Stedman
mesh_terms: D000328:Adult; D001034:Apgar Score; D001946:Breech Presentation; D016022:Case-Control Studies; D036861:Delivery, Obstetric; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D006863:Hydrogen-Ion Concentration; D011247:Pregnancy; D011256:Pregnancy Outcome; D011391:Prolapse; D012189:Retrospective Studies; D014470:Umbilical Cord / Q000737:chemistry