title: Retrospective cohort study: a comparison of two different management strategies in patients with preterm premature rupture of membranes.
abstract: OBJECTIVE
  Perinatal outcomes were compared before and after changes in the treatment policy to improve the management for preterm PROM (pPROM).
  
  
  METHODS
  This is a retrospective analysis of 99 cases of pPROM diagnosed between 27 and 34 weeks of gestation, which were managed according to the following two different protocols. Group A (47 cases): tocolytic therapy was continued to prevent preterm delivery until clinical chorioamnionitis (CAM) was diagnosed between January 2000 and June 2004. Group B (52 cases): labor was induced or cesarean section performed when oligohydramnios was diagnosed and/or elevation elastase (EL) of amnion was detected by amniocentesis between July 2004 and July 2009. The outcomes of the cases in each group were compared with regard to the extension of pregnancy period, reasons for delivery, perinatal complications, stage of pathological CAM and funisitis (FUN), neonatal serum IgM concentration, mortality, and morbidity.
  
  
  RESULTS
  The incidences of pathological CAM and FUN were significantly lower in Group B than in Group A. The concentration of neonatal serum IgM was also significantly lower in Group B than in Group A.
  
  
  CONCLUSIONS
  The addition of oligohydramnios and elevation EL of amnion as indicative factors of intrauterine infection might lead to a reduction in the severity of fetal infection in cases of pPROM.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
authors.forename: Azusa
authors.initials: A
authors.lastname: Shinjo
authors.forename: Katsufumi
authors.initials: K
authors.lastname: Otsuki
authors.forename: Maki
authors.initials: M
authors.lastname: Sawada
authors.forename: Hajime
authors.initials: H
authors.lastname: Ota
authors.forename: Mayumi
authors.initials: M
authors.lastname: Tokunaka
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Oba
authors.forename: Ryu
authors.initials: R
authors.lastname: Matsuoka
authors.forename: Takashi
authors.initials: T
authors.lastname: Okai
mesh_terms: D000328:Adult; D000649:Amniocentesis; D002585:Cesarean Section; D002821:Chorioamnionitis / Q000175:diagnosis; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D046689:Fetal Mortality; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007231:Infant, Newborn; D007751:Labor, Induced; D019272:Leukocyte Elastase / Q000032:analysis; D016104:Oligohydramnios / Q000175:diagnosis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D015149:Tocolytic Agents / Q000627:therapeutic use
chemical_list: D007075:Immunoglobulin M; D015149:Tocolytic Agents; D019272:Leukocyte Elastase