title: Conservative management of preterm premature rupture of membranes beyond 32 weeks' gestation: is it worthwhile?
abstract: We aimed to investigate whether conservative management of preterm premature rupture of membranes (PPROM) at 32-34 weeks' gestation improves outcome. In this retrospective analysis of singleton pregnancies, the study group included patients with PPROM at 28-34 weeks' gestation and the control group included patients presented with spontaneous preterm delivery at 28-34 weeks' gestation. Both groups were subdivided according to gestational age - early (28-31 weeks' gestation) versus late (32-34 weeks' gestation). Adverse neonatal outcome included neonatal death, intraventricular haemorrhage grade 3/4, respiratory distress syndrome, periventricular leucomalacia and neonatal sepsis. The study and control groups included 94 and 86 women, respectively. The study group had a lower incidence of adverse neonatal outcome at the earlier weeks (28-31), compared with the control group at the same gestational age. In contrast, at 32-34 weeks' gestation no difference in the risk for adverse neonatal outcome was noticed. Additionally, within the study group, chorioamnionitis rate was significantly higher among those who delivered at 32-34 weeks' gestation (p < 0.01). No advantage for conservative management of PPROM was demonstrated beyond 31 weeks' gestation. Moreover, conservative management of PPROM at 32-34 weeks' gestation may expose both mother and neonate to infectious morbidity.
authors.affiliation: a The Department of Gynecology.
authors.forename: Z
authors.initials: Z
authors.lastname: Tsafrir
authors.affiliation: a The Department of Gynecology.
authors.forename: G
authors.initials: G
authors.lastname: Margolis
authors.affiliation: a The Department of Gynecology.
authors.forename: Y
authors.initials: Y
authors.lastname: Cohen
authors.affiliation: a The Department of Gynecology.
authors.forename: A
authors.initials: A
authors.lastname: Cohen
authors.affiliation: a The Department of Gynecology.
authors.forename: I
authors.initials: I
authors.lastname: Laskov
authors.affiliation: a The Department of Gynecology.
authors.forename: I
authors.initials: I
authors.lastname: Levin
authors.affiliation: b Neonatal Intensive Care Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University , Tel Aviv , Israel.
authors.forename: D
authors.initials: D
authors.lastname: Mandel
authors.affiliation: a The Department of Gynecology.
authors.forename: A
authors.initials: A
authors.lastname: Many
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data; D002821:Chorioamnionitis / Q000453:epidemiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology; D007902:Length of Stay; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Conservative management; chorioamnionitis; outcome; preterm premature rupture of membranes