Contemporary Management of Preterm Premature Rupture of Membranes: Determinants of Latency and Neonatal Outcome

Preterm premature rupture of membranes (PPROM) is responsible for 30% of neonatal morbidity and mortality in premature gestations. We sought to evaluate pregnancy outcomes in PPROM managed uniformly with antibiotics and steroids, and to determine what maternal factors influence latency. This was a retrospective analysis of 134 patients at 24 to 31.9 weeks with PPROM. Associations of maternal and pregnancy characteristics with latency were evaluated by chi-square for linear trend, nonparametric tests, or multivariable linear regression, as appropriate. Forty-three of 134 women (32%) had latencies greater than a week. Gestational age (p < 0.001), admission white blood cell count (p = 0.001), and amniotic fluid index (p = 0.02) were independently predictive of latency. Histopathologic funisitis increased with pregnancy length. There were no fetal deaths or significant intraventricular hemorrhage past 28 weeks.

Preterm premature rupture of membranes - latency - neonatal outcome

REFERENCES

• 1 Romero R, Athayde N, Maymon E, Pacora P, Bahado-Singh R. Premature rupture of the membranes. In: Medicine of the Fetus and Mother. Philadelphia; Lippincott-Raven 1999: 1581-1626
• 2 Cox S M, Williams M L, Leveno K J. The natural history of preterm ruptured membranes: what to expect of expectant management.  Obstet Gynecol. 1988;  71 558-562
• 3 Nelson L H, Andreson R L, O'Shea M, Swain M. Expectant management of preterm premature rupture of membranes.  Am J Obstet Gynecol. 1994;  171 350-358
• 4 Philipson E H, Hoffman D S, O'Hansen G O, Ingardia C J. Preterm premature rupture of the membranes: experience with latent periods in excess of seven days.  Am J Perinatol. 1994;  11 416-419
• 5 Mercer B M, Miodovnik M, Thurnau G R et al.. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes: a randomized controlled trial.  JAMA. 1997;  278 989-995
• 6 Kenyon S L, Taylor D J, Tarnow-Mordi W et al.. Broad-spectrum antibiotics for preterm, prelabor rupture of the fetal membranes: the ORACLE I randomized trial.  Lancet. 2001;  357 979-988
• 7 Romero R, Yoon B H, Mazor M et al.. A comparative study of the diagnostic performance of amniotic fluid glucose, white blood cell count, interleukin-6, and gram stain in the detection of microbial invasion in patients with preterm premature rupture of membranes.  Am J Obstet Gynecol. 1993;  169 839-851
• 8 Romero R, Quintero R, Oyarzun E et al.. Intramniotic infection and the onset of labor in preterm premature rupture of the membranes.  Am J Obstet Gynecol. 1988;  159 661-666
• 9 NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes . Effect of corticosteroids for fetal maturation on perinatal outcomes.  JAMA. 1995;  273 413-418
• 10 Vermilion S T, Kooba A M, Soper D E. Effectiveness of antenatal corticosteroid administration after preterm premature rupture of the membranes.  Am J Obstet Gynecol. 2000;  183 925-929
• 11 Lewis D F, Brody K, Edwards M S, Brouillete R M, Burlison S, London N S. Preterm premature ruptured membranes: a randomized trial of steroids after treatment with antibiotics.  Obstet Gynecol. 1996;  88 801-805
• 12 Nugent R P, Krohn M A, Hillier S L. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation.  J Clin Microbiol. 1991;  29 297-301
• 13 Hillier S L, Nugent R P, Eschenbach D A et al.. Association between bacterial vaginosis and preterm delivery of a low-birth-weight-infant.  N Engl J Med. 1995;  333 1737-1742
• 14 Hauth J C, Goldenberg R L, Andrews W W, DuBard M B, Copper R L. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis.  N Engl J Med. 1995;  333 1732-1736
• 15 Vermillion S T, Kooba A M, Soper D E. Amniotic fluid index values after premature rupture of the membranes and subsequent perinatal infection.  Am J Obstet Gynecol. 2000;  183 271-276
• 16 Vintzileos A M, Campbell W A, Nochimson D J, Weinbaum P J. Degree of oligohydramnios and pregnancy outcome in women with preterm premature rupture of membranes.  Obstet Gynecol. 1985;  66 162-167
• 17 Wu Y W, Colford J M. Chorioamnionitis as a risk factor for cerebral palsy: a meta-analysis.  JAMA. 2000;  284 1417-1424
• 18 Yoon B H, Romero R, Park J S et al.. Fetal exposure to intra-amniotic inflammation and the development of cerebral palsy at the age of three years.  Am J Obstet Gynecol. 2000;  182 675-681