title: Economical Analysis of Different Clinical Approaches in Pre-Viability Amniorrhexis-A Case Series.
abstract: Prolonged oligohydramnios following extreme preterm prelabour rupture of membranes (EPPROM) is traditionally associated with a high morbidity and mortality to both the mother and the baby. The clinical maternal evaluation and fetal ultrasound assessment may provide important prognostic information for the clinicians and should be taken into account when counselling the patients so as to provide them with enough information to make decision of continuing or interrupting the pregnancy. Current financial constraints on the National Healthcare Service (NHS) resources make it imperative for clinical decision-makers and budgetary planners to make the right decision of continuing or terminating a second trimester pre-viability amniorrhexis for desperate parents. To assess the economic consequences following EPPROM, the risk of infection to both baby and mother, psychological impact on the parents and associated complications and further disability after delivery on this fragile group of patients to the NHS resources. We review the clinical course, outcome, and the challenges to parents and health care professionals on three pregnancies complicated by EPPROM, occurring before 24 weeks' gestation with a membrane rupture to delivery interval (latent period) of 14 days or more. The anticipated birth of an extremely premature infant poses many challenges for parents and health care professionals. As parents are faced with difficult decisions that can have a long-term impact on the infant, family and country's resources, it is critical to provide the type of information and support that is needed by them. Taking all these into consideration with the period of ventilation and respiratory assistance in Neonatal Intensive Care Unit (NICU) is essential to provide maximum chances for survival, minimizing the risk for long term sequelae of the neonate and provides the parents enough time to decide on making the right decision with the associated guidance of the healthcare provider.
authors.affiliation: Department of Obstetrics and Gynecology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK. engemisesam@doctors.org.uk.
authors.forename: Samuel
authors.initials: S
authors.lastname: Engemise
authors.affiliation: Department of Child Health, Northampton General Hospital NHS Trust, Northampton NN1 5BD, UK. fiona.thompson@ngh.nhs.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Thompson
authors.affiliation: Department of Obstetrics and Gynecology, Northampton General Hospital NHS Trust, Northampton NN1 5BD, UK. william.davies@ngh.nhs.uk.
authors.forename: William
authors.initials: W
authors.lastname: Davies
keywords: EPPROM; National Healthcare Services (NHS) resources; PPROM; amniorrhexis