[Analysis of 42 membrane ruptures during the second pregnancy trimester]

65 cases of premature rupture of the membranes before the 28th week of amenorrhoea occurred during the 5 years between 1983 and 1987 in two maternity units in Paris. A retrospective study was carried out on 42 of these cases where conservative measures had been decided on. In two-thirds of the cases, of which 42% had had bleeding and 40% vaginal infection, the pregnancy had appeared to be progressing normally before the rupture of the membranes. 14% had had cerclage and 12% had had selective intrauterine fetal reduction or biopsy of the trophoblast or removal of an intrauterine device. Rupture of the membranes rarely happens in isolation because it is usually accompanied by uterine contraction or bleeding, which may occur separately or associated with one another in half the cases. In 21% of cases bacteriological examination was positive after the rupture. All patients were treated conservatively in this study. Antibiotics were prescribed in 35 cases and tocolysis in 13 cases. The membranes were ruptured on an average for 7 days. It was almost impossible to avoid infection except in two patients who delivered rapidly. The pregnancies resulted in 8 intrauterine deaths, 15 deliveries of babies that were not viable, 19 deliveries of live babies of which 7 were by caesarean section. 15 babies survived the neonatal period. This work makes it possible to judge whether it is really hazardous to try to be conservative before the 24th week of amenorrhea. Even if neonatal mortality is being lowered at term, overall in our series it was 25%. Finally, it does not seen that tocolytics or antibiotics help to lower this mortality significantly.