Prolonged rupture of the fetal membranes and neonatal outcome

In order to establish the incidence of neonatal infection following prolonged (greater than 24 hours) rupture of the fetal membranes (PROM) and assess outcome of two year retrospective study was undertaken. The names of all babies born following PROM were obtained from the computerised obstetric record and the bacteriological results and outcome reviewed. Of 208 babies born following PROM only three had blood cultures containing pathogens--all of whom were of less than 1500 g birthweight and all of whom died. This represents a fivefold increased frequency of infection for premature babies but no increased risk for full term babies. The overall incidence of infection was much lower than in previous series and this may be due to performing amniocentesis as soon as possible following rupture and inducing labour where there was evidence of incipient chorioamnionitis. Meningitis was not associated with prolonged rupture of the membranes. The mortality for these babies was higher than those of babies without PROM in the 28-31 week gestation group. This was strongly associated with early onset of membrane rupture and none of the babies born following membrane rupture prior to 20 weeks gestation survived. Non-infective pulmonary disease was the main cause of increased mortality.