title: Pulmonary effects of prolonged oligohydramnios following mid-trimester rupture of the membranes--antenatal and postnatal management.
abstract: Mid-trimester, preterm prelabour rupture of the membranes (PPROM) with prolonged oligohydramnios remains a challenge for both obstetricians and neonatologists. Although survival rates have improved, morbidity remains common particularly due to pulmonary insufficiency and pulmonary hypertension. The aetiology of abnormal lung development is unknown but may depend critically on pulmonary vascular development. Antenatal evaluation of at-risk foetuses by three-dimensional ultrasound and MRI is possible but the techniques need to be further assessed. Antenatal corticosteroids given in cases of PPROM reduce the incidence of neonatal death, respiratory distress syndrome, intraventricular haemorrhage and necrotising enterocolitis without increasing maternal or neonatal infection. The true risk-benefit ratio of antibiotics, tocolysis and strategies to normalise amniotic fluid volume remains less clear. There is no consensus regarding the optimal ventilation strategy to support infants with pulmonary insufficiency following PPROM, and further work is required to determine whether and which pulmonary vasodilators improve long-term outcome in these infants.
authors.affiliation: Department of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium. olivia.williams@uclouvain.be
authors.forename: Olivia
authors.initials: O
authors.lastname: Williams
authors.forename: Graham
authors.initials: G
authors.lastname: Hutchings
authors.forename: Corinne
authors.initials: C
authors.lastname: Hubinont
authors.forename: Christian
authors.initials: C
authors.lastname: Debauche
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000188:drug therapy / Q000517:prevention & control; D020345:Enterocolitis, Necrotizing / Q000188:drug therapy / Q000517:prevention & control; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000254:growth & development; D008171:Lung Diseases / Q000188:drug therapy; D016104:Oligohydramnios / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000517:prevention & control
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents