Conservative Versus Aggressive Management of Preterm Rupture of Membranes

ABSTRACT

Amniocentesis to guide the management of preterm pregnancies complicated by premature rupture of the membranes (PROM) has been adopted at several centers. The purpose of this study was to evaluate this practice prospectively among comparable groups of patients, which has not previously been reported. Forty-seven patients with PROM at 26 to 34 weeks of gestation and an accessible pocket of amniotic fluid by ultrasound examination were randomly assigned to an “amniocentesis group” (N = 25) or to a “no amniocentesis group” (N = 22). Amniocentesis results were utilized when making management decisions in the amniocentesis group, whereas a clinical basis alone was used in the no amniocentesis group. Demographic variables were similar between the two study populations at the time of randomization. There were no antepartum fetal deaths and one neonatal death in each group. Fetal distress, as judged by the fetal monitor tracing, was more frequent in the no amniocentesis group (P <.05). The number of days the infant remained in the hospital was significantly less in the amniocentesis group (median = 8.5 days, range 2 to 88 days) than in the no amniocentesis group (median = 22 days, range 2 to 110 days, P <.01). This difference in neonatal hospital days appeared to be mainly due to a slower resolution of the multiple problems of prematurity. No significant differences in these complications were demonstrated individually. No differences in antepartum hospital days, postpartum hospital days, post-partum endometritis, or sepsis were apparent between the two groups. We conclude that amniocentesfs appears to be an effective diagnostic adjunct in the management of PROM and results in decreased neonatal hospitalization and fetal distress in labor.