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Conservative Management of Patients with Premature Rupture of Fetal Membranes

From the US Air Force Medical Corps, Department of Obstetrics and Gynecology, Wilford Hall USAF Medical Center, Lackland Air Force Base, San Antonio, Texas

Abstract

The management of pregnant patients with premature rupture of membranes (PROM) prior to 32 weeks' gestation or at 32 to 34 weeks' gestation is controversial. In a retrospective analysis of 109 patients with PROM at or prior to 34 weeks' gestation, 53 (49%) were managed conservatively, and labor was either induced or occurred spontaneously within 24 hours in 56 (51%). Patients initially presenting with chorioamnionitis were excluded from this study, as were all patients with evidence of a fetal anomaly or a medical indication for delivery. The 53 patients managed conservatively had a mean pregnancy prolongation of 21 days (range, 2 to 105 days; median, 7 days). The infants of patients managed conservatively had a lower incidence of respiratory distress syndrome (P<.0025), mortality (P<.05), and intracranial hemorrhage (P<.03). Sixty-four percent of the conservatively managed group versus 45% of the induced/ spontaneous labor group were found to be normal upon physical and neurologic examination when discharged from the hospital (P<.035). The difference in incidence of neonatal sepsis between these 2 groups was not statistically significant (P = .42). Immediate induction of labor and/or delivery for patients with PROM at less than 32 weeks' gestation resulted in a significant increase in perinatal mortality and morbidity.