WS02‐02Management of premature rupture of the membranes by ultrasound

Abstract

Objective In pregnancies complicated by preterm premature rupture of the membranes (pPROM) there are essentially two causes of perinatal death: prematurity and lung hypoplasia. We used ultrasound to try to predict these complications. Design and methods The cervical length was measured by transvaginal ultrasound in 167 pregnancies complicated by pPROM < 32 weeks of gestation. Further in 20 pregnancies with pPROM before 24 weeks of gestation peripheral pulmonary artery (PPA) waveforms were recorded by Doppler technique at weekly interval until delivery and the Pulsatility Index (PI) calculated. Pregnancies were managed conservatively according to an Institutional management protocol. The occurrence of preterm delivery and pulmonary hypoplasia was evaluated and related to ultrasound findings. Results The cervical length at admission predicts the time interval elapsing between pPROM and delivery. Significant differences in PI values from PPA were present from 2 weeks onwards the pPROM between the fetuses who developed pulmonary hypoplasia and those with a normal outcome. Conclusion The measurement of the cervical length and of PPA velocity waveforms may help to establish the risk of developing prematurity and pulmonary hypoplasia in pregnancies complicated by pPROM.