Preterm premature rupture of membranes: detection of infection

This prospective study was designed to determine the value of a daily modified biophysical profile in detecting infection in patients with preterm premature rupture of the membranes who were managed expectantly. Ninety-nine patients received daily nonstress tests and biophysical profile scores. Results of the last predelivery study were related to subsequent development of amnionitis or fetal sepsis. Infection was present in 16 patients. When the biophysical profile score was 0/8, infection was uniformly present. When fetal breathing was absent (biophysical profile score, less than or equal to 4/8) and nonstress test was nonreactive, infection was present in 75% of cases (sensitivity, 75%; specificity, 95%). Because a nonreactive nonstress test could be secondary to prematurity instead of infection, these results were analyzed over time. Those who initially had a reactive nonstress test that subsequently became nonreactive were more likely to be infected. We conclude that a daily biophysical profile score and nonstress test can detect infection and propose delivery of patients with a biophysical profile score of 0/8 and nonreactive nonstress test. Patients with absent fetal breathing and a nonstress test that changes from reactive to nonreactive also should be considered for delivery. Absent fetal breathing with a reactive nonstress test or a consistently nonreactive nonstress test should have further testing to rule out infection.