Tests of fetal well-being in premature rupture of membranes

In summarizing the published data on the use of amniocentesis and fetal biophysical assessment in managing patients with PROM the following conclusions may be drawn: 1. Both amniocentesis and fetal biophysical assessment are reasonably good methods to predict the fetus who is doing well and could therefore safely remain in utero, as well as the fetus who is at high risk for developing sepsis and therefore in need of delivery. 2. Consideration of routine transabdominal amniocentesis for Gram stain and cultures in patients with PROM is reasonable. Measurements of glucose levels, esterase activity, or cytokines are only investigational, and their use in patient management cannot be advocated at this time. 3. Although there are no prospective controlled randomized trials to prove improved pregnancy outcome by the use of either amniocentesis or frequent biophysical assessment, nonrandomized comparative trials as well as trials using historic controls suggest that the use of either or both techniques in combination may be beneficial in managing PROM.