684: Impact of amniocentesis on the natural history of preterm premature rupture of the membranes

Abstract

RUPTURE OF THE MEMBRANES SEAN BLACKWELL, JERRIE REFUERZO, YORAM SOROKIN, STANLEY BERRY, University of Texas Health Science Center at Houston, Houston, Texas, Wayne State University, Detroit, Michigan, William Beaumont Hospital, Obstetrics and Gynecology, Royal Oak, Michigan OBJECTIVE: The clinical utility of amniocentesis in the management of pregnancies complicated by preterm premature rupture of the membranes (PPROM) remains controversial. The objectives of this study were to determine 1) how often amniocentesis leads to a significant change in clinical management of PPROM and 2) what effect amniocentesis has on the natural history of PPROM. STUDY DESIGN: Singleton, liveborn pregnancies complicated by PPROM at 24-34 wks which delivered between 1/1995-6/20000 were studied. Both maternal and neonatal hospital charts were reviewed for pertinent clinical and outcome data. Women who had active labor, clinical chorioamnionitis or non-reassuring fetal status on admission were excluded. Clinical outcomes of PPROM patients who underwent amniocentesis were compared to those who did not. A p 0.05 was considered significant. RESULTS: During the study period 310 patients met all criteria. Of these patients 58 (18.7%) underwent amniocentesis and 252 did not. There were no differences in maternal age, race, parity, insurance status or gestational age at PPROM. Of the women in the amniocentesis group, 48.2% had a change in managment based on the amniocentesis (delivery or adjustment of antibiotic regimen). In the no amniocentesis group 31% (78/252) were induced; 9.8% due to clinical chorioamnionitis, 13.9% for non-reassuring fetal status, and 7.1% for other indications. Amniocentesis patients had higher induction rates (67% vs. 31%; p 0.01), but longer latency periods (median 96 hours [range 8-1632] vs. 55 [4-1782]; p 0.002) than those without amniocentesis. CONCLUSION: The findings of our study suggest that the use of amniocentesis in PPROM may alter clinical management in up to 48% of cases. Amniocentesis may be associated with a longer latency period and delay in delivery by selecting optimal candidates for expectant management.Whether this would result in decreased neonatal morbidity remains unknown.