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Intentional delivery versus expectant management with preterm ruptured membranes at 30-34 weeks' gestation
1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School, Dallas, USA.
Objective:
To determine maternal and neonatal outcomes in pregnancies complicated by preterm rupture of membranes (PROM) at 30-34 weeks' gestation.
Methods:
A randomized controlled trial was conducted to study the benefits of expectant management in women hospitalized for PROM at 30-34 weeks' gestation. During this investigation, no tocolytics, corticosteroids, or prophylactic antibiotics were used.
Results:
Sixty-eight women with PROM were managed expectantly and 61 were delivered intentionally. The mean gestational age at study entry was 31.7 weeks in both the expectant management and intentional delivery groups (P > .05). The mean gestational ages at delivery were similar (32.0 and 31.7 weeks, respectively). Other indices of pregnancy outcome (ie, birth weight, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, respiratory distress syndrome, and perinatal death) were not significantly improved by expectant management. However, there was a significant increase in the incidence of chorioamnionitis and antepartum hospitalization in the women managed expectantly.
Conclusion:
There were no clinically significant neonatal advantages to expectant management of ruptured membranes at 30-34 weeks. Antepartum hospitalization was decreased by 2.5 days in those women randomized to intentional delivery.