Neonatal outcome after prolonged rupture of the membranes starting in the second trimester.

Abstract

SUMMARY The neonatal outcomes of 30 pregnancies that were complicated by premature and prolonged rupture of the membranes that had started in the second trimester of pregnancy, were reviewed. The neonatal mortality was 11 (36%), the main cause of death being pulmonary hypoplasia. Two infants died of sepsis, but these were the only proved episodes of maternal or fetal infection. Of the survivors 27% developed compressive limb abnormalities, all of which responded to passive physiotherapy. Pulmonary hypoplasia was significantly associated with earlier onset of rupture of the membranes, and the absence of fetal breathing movements. Compressive limb abnormalities were significantly associated with longer periods of oligohydramnios. We conclude that premature rupture of the membranes, even with onset in the second trimester, may be associated with a favourable outcome and this may be predicted by the persistence of fetal breathing movements. We therefore, recommend expectant management of such pregnancies, but suggest elective delivery at 34 weeks to limit fetal exposure to uterine compression and minimise the risks of prematurity.Premature rupture of the membranes is a common complication of pregnancy.' When it occurs in the second trimester the prognosis is poor,2 and as a consequence termination of the pregnancy is often recommended. The neonates may have pulmonary hypoplasia, altered facies, and aberrant limb development (Potter's syndrome).3 Premature rupture of the membranes permits chronic drainage of amniotic fluid resulting in oligohydramnios, so such abnormalities may be the result of prolonged compression of the fetus by the uterus in the absence of the usual 'cushion' of amniotic fluid.4 Pulmonary hypoplasia has been reported after oligohydramnios of only six days' duration,5 but it has been suggested that compressive abnormalities are more likely to develop after chronic reduction in the amount of amniotic fluid.2 Our preliminary report, however, included normal survivors of pregnancies complicated by severe oligohydramnios that had existed for as long as 17 weeks.6The aim of the present study was to follow prospectively a larger series of pregnancies complicated by prolonged rupture of the membranes that had started in the second trimester in an attempt to find out the neonatal mortality and morbidity. We hoped to determine the association between the onset and duration of rupture of the membranes and mortality and morbidity, and find out if the persistence of fetal breathing movements is a reliable indicator of favourable neonatal outcome.6Patients and methods During a period of one year all pregnancies with rupture of the membranes of longer than two weeks' duration occurring in the second trimester were eligible for entry into the study. The various options in management and the prognosis of pregnancies complicated by premature rupture of the membranes were carefully explained to the patients referred to our unit and their partners. If a patient then decided to be treated expectantly she was entered ...

Survey of Pregnancy Outcome in Preterm Premature Rupture of Membranes with Amniotic Fluid Index

“…[1][2][3][4]9 Since amniotic fluid has certain bacteriostatic properties which protect against potential infection, it seems that a decrease in amniotic fluid volume may impair the pregnant women's ability to combat such infections and cause an increased risk of infection. 3,10,11 The aim of this study is to survey pregnancy outcome in PPROM with an amniotic fluid index of <5 and ≥5.…”

“…Since PPROM is associated with lower latency from membrane rupture until delivery, it is an important cause of perinatal morbidity and mortality. [1][2][3] During the latency period, the ascent of pathogenic microorganisms from the lower genital area could create complications such as intrauterine infections. [4][5][6][7][8] Also, some studies introduced PROM as a pathologic process that often occurs following membrane inflammation and infection.…”

Steroid usage in pregnancies complicated by preterm premature rupture of the membranes

“…Our control patients were selected only because of premature delivery and included, as in other series, patients with pregnancy complications that necessitated immediate delivery or who had presented in well established labour. In contrast patients with PPROM may deliver many days or even weeks after their initial presentation [1,2]. It is thus not surprising that a significantly greater proportion of our PPROM patients compared to the controls received antenatal steroid therapy.…”

“…Many patients with PPROM, but an otherwise uncomplicated pregnancy, are managed conservatively [1,3]. Conservative management includes antenatal administration of corticosteroids [2], which in patients with PPROM has been demonstrated to be effective prophylaxis against neonatal respiratory distress syndrome (RDS) [6,9].…”

Prediction of lethal pulmonary hypoplasia and chorioamnionitis by assessment of fetal breathing

“…A possible explanation for these conflicting results may be the different definitions used for FB and pulmonary hypoplasia. Moessinger et al (1987) used lung DNA content or lung/body weight ratio or both at autopsy, whereas Blott et al (1988) used a lung/body weight ratio of ≤0.012 and a radial alveolar count (performed on inflated lungs) of ≤4.1 (Askenazi & Perlman 1979). We used a lung/birthweight ratio of ≤0.012 (Askenazi & Perlman 1979) or a radial alveolar count more than 1 SD below the normal value (for un‐inflated lungs) for the corresponding gestational age according to Emery & Mithal (1960).…”