[Premature rupture of fetal membranes--diagnosis and management]

To investigate the reasons for preterm premature rupture of amnionic membranes (PPRAM), the methods for diagnosis and for identification of the syndrome of amnionic infection as well as to define the behaviour in relation to gestational age.

The study covered 859 premature newborns of which, 283 (32.95%) were delivered by mothers presenting with PPRAM. The following methods were made use of: inspection by using speculum, "fern test", pH with nitrazine paper, and ultrasound examination. The amnionic infection was proved by means of measurement of body temperature and heart rate, leukocyte number and differential blood test, C-reactive protein, microbiological examination of the amniotic fluid including the diagnostic polymerase chain reaction as well as by histological examination of the amnionic membranes.

The most common reasons for PPRAM were the following: histologically proved chorioamnionitis (in 15.55%), bleeding during the present pregnancy (in 14.84%), preceding PPRAM or preterm delivery (in 10.95%), multifoetus pregnancy (in 4.59%), isthmicocervical insufficiency (in 3.89% of the cases), etc. No dependence between the histological evidence of a chorioamnionitis and the time passed since PPRAM and between the bacterial contamination of the amniotic fluid and the presence of amnionitis could be established at all. In the protocol, the rules for the application of corticosteroids, antibiotics and tocolytics in dependence on the gestational age and the obstetric behaviour such as expecting, labour induction, or Cesarean section were defined.