Prolonged Rupture of Membranes in the Term Newborn

Abstract

Of 8791 consecutive newborns, we studied 205 (2.3%) women with a history of prolonged rupture of membranes (PROM) greater than 24 hr to assess the incidence of infection, to identify the rate of clinical symptoms, and to examine the use of the white blood count (WBC) and neutrophil values as screening tools to predict infection. Blood culture and complete blood counts (CBC) were obtained in 175 (85%). Fifteen (8.2%) had positive blood cultures including group B streptococcus, streptococcus viridans, streptococcus pneumoniae, staphlococcus epidermidis, and staphlococcus aureus. In the remaining 8586 infants born to mothers without PROM, 10 had positive blood cultures for an incidence of 0.1%. In the PROM group, the six who manifested clinical symptoms had abnormal CBCs; abnormal white blood count (2), abnormal neutrophil count (5), high band/metatamyelocyte count (4), and increased immature to total neutrophil ratio (4). Of the nine asymptomatic infants, seven (78%) had abnormal CBCs, five (56%) with a high WBC, five (56%) had a high neutrophil count, two (22%) had a high band/metatamyelocyte count, and one a high immature to total neutrophil ratio. CBC values were obtained from infants with PROM and negative blood cultures. Five of these 15 controls had an abnormal CBC. In the term newborn, PROM is associated with significantly increased incidence of positive blood cultures. The sensitivity of the CBC was 86% and specificity 66%. In view of this data a conservative clinical approach utilizing blood cultures and CBC evaluations in the management of PROM is warranted.

Measurement of Placental Alpha-Microglobulin-1 in Cervicovaginal Discharge to Diagnose Rupture of Membranes

“…Although preterm PROM is associated with significant perinatal and maternal mortality and morbidity, [1][2][3][4] an accurate test to confirm the diagnosis has been lacking. 7,11 This is due primarily to the fact that the traditional "gold standard" for the diagnosis of ROM is subjective.…”

Placental alpha microglobulin-1 (AmniSure® test) for detection of premature rupture of fetal membranes

“…Failure to identify patients with PROM can result in failure to implement the standard measures and conversely an incorrect diagnosis leads to inappropriate interventions (such as hospitalization or induction of labor). Therefore, the diagnosis of PROM is of critical importance to avoid serious fetal or maternal consequences [5,6].…”

Comparison between Amnisure Placental Alpha Microglobulin-1 Rapid Immunoassay and Standard Diagnostic Methods for Detection of Rupture of Membranes

“…Preterm PROM is associated with significant maternal and perinatal mortality and morbidity [3, 22, 24, 25]. Unfortunately, there is absence of an accurate and simple diagnostic tool to establish the diagnosis [6, 10] as the traditional way to diagnose ROM is subjective.…”