Abstract
Prelabor preterm rupture of the membranes (PPROM) refers to the rupture of the membranes before 37 weeks, but also before the onset of labor. Approximately 3% of pregnancies are complicated by PPROM, which is an important cause of neonatal morbidity and mortality. The aim of the study is to demonstrate the benefit of expectant management in PPROM, compared to immediate birth, defined in our study as birth in the first 48 h. We analyzed 562 pregnancies with PPROM by gestational age groups and short-term morbidities. Material and methods: We conducted a retrospective observational analytical study, which included women with PPROM between 24 + 0 and 36 + 6 weeks. We divided the cohort into gestational age groups: group 1 gestational age (GA) between 24 and 27, group 2 GA between 28 and 31, group 3 GA between 32 and 34, group 4 GA > 35 weeks. In each group, we analyzed the benefit of the latency period (established in our study as delivery after 48 h of hospitalization) in terms of short-term neonatal complications. Result: The latency period brought a significant benefit starting with GA greater than 28 weeks; therefore, in the group with GA between 28–31, the complications were significantly statistically lower, mentioning respiratory distress syndrome (no latency 100% vs. latency 85.1%) and admission to the neonatal intensive care unit (no latency 89.7% vs. latency 70.2%). In group 3, with GA between 32–34, we reached statistical significance in terms of respiratory distress syndrome (no latency 61.8% vs. latency 39%), hypoxia (no latency 50% vs. latency 31.7%) and admission to the neonatal intensive care unit (no latency 70.2% vs. latency 47.4%). Conclusion: Expectant management of pregnancies with PPROM can bring a real benefit in terms of the incidence of complications in premature infants, but this benefit depends most on the gestational age at which the membranes ruptured and the medical conduct put into practice during the latency period.
Highlights
Introduction distributed under the terms andPrelabor preterm rupture of the membranes (PPROM) refers to the rupture of the membranes before 37 weeks and before the onset of labor
Expectant management of pregnancies with PPROM can bring a real benefit in terms of the incidence of short-term complications in premature infants
We believe that this depends on several important factors, including the gestational age at which the rupture of membranes occurred, as we have shown that latency is higher in young gestational ages
Summary
Introduction distributed under the terms andPrelabor preterm rupture of the membranes (PPROM) refers to the rupture of the membranes before 37 weeks and before the onset of labor. PPROM occurs in up to 3 percent of pregnancies, and one in three premature births has this pathogenic mechanism [1]. Diagnosis of PPROM is simple if the rupture is obvious, and we can notice the leakage of the amniotic fluid from the cervix. If these cannot be observed, diagnosis is based on a thorough anamnesis and some simple diagnostic tests: rapid strip tests for amniotic fluid leakage measuring the vaginal pH that becomes alkaline in the presence of amniotic fluid, analysis on the microscope slide of fluid collected from posterior vaginal fornix that crystallizes in the presence of amniotic fluid due to the high content of salts and proteins and ultrasound evaluation [5]
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