Amniocentesis for PPROM management: a feasibility study

In Canada, most mothers whose amniotic membranes rupture before 34 weeks' gestation are hospitalized and delivered when signs of chorioamnionitis or fetal distress are observed or when a predetermined gestational age between 34 and 37 weeks is reached. This management approach can be questioned because in utero exposure to infection is a risk factor for cerebral palsy in neonates. Amniocentesis has the potential to detect markers of intra-amniotic infection. Our objective was to determine the acceptability of a randomized study comparing expectant management with amniocentesis-based management in women with premature rupture of the membranes.

Between November 2005 and January 2007, we conducted a qualitative study involving 40 patients admitted to a tertiary care centre with premature rupture of the membranes between 28 and 34 weeks. The participants read an information booklet and answered a questionnaire. They were asked if they would agree to participate in a randomized study comparing expectant management with amniocentesis-based management. They graded the importance of a series of statements in their decision-making process.

Seventy percent (28/40) of patients would have participated in the proposed study. Determining the presence of amniotic fluid infection or lung maturity was the main reason motivating their choice. The reasons for refusing to participate were related to complications of amniocentesis (fetal trauma, iatrogenic preterm labour, infection, or pain).

The majority of patients with premature rupture of the membranes would participate in a study comparing expectant management to management based on amniocentesis results. This study helped us to better understand their motivations and fears.