Study on the Management of Pregnancies Complicated by Late Preterm Prelabour Rupture of Membranes between 34 and 37 Weeks of Gestation in Woman's Health Centre-Assiut University: A Prospective Study,
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- Category: Vol. 81, December 2013
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Study on the Management of Pregnancies Complicated by Late Preterm Prelabour Rupture of Membranes between 34 and 37 Weeks of Gestation in Woman's Health Centre-Assiut University: A Prospective Study, HAZEM S. MOHAMAD
Abstract
Background: Preterm prelabour rupture of membranes (PPROM) is the rupture of membranes during pregnancy before the end of 37 weeks gestation. It occurs in approximately 2-20% of pregnancies and is the cause of about one third of preterm deliveries. PPROM is associated with 18-20% of perinatal deaths. It can lead to significant perinatal morbidity. Treatment varies depending on gestational age, and includes consideration of delivery when rupture of membranes occurs at or after 34 weeks gestation.
Objectives: The aim of this study was to determine the scope of problem of (PPROM) in Woman's Health Center-Assiut University and to address a question about which is better, the expectant management or the descision of labour induction.
Design and Setting: A randomised prospective controlled study was carried out in Woman's Health Centre-Assiut University during the period from first of July 2012 to 31 of December 2012-Assiut-Egypt. Participants were randomly ablocated in a 1:1 ratio to induction of labour or expectant management using block randomisation.
Patients and Methods: One hundred, non-laboring, preg-nant women with more than 24-hours of PPROM between 34 (+0) and 37 (+0) weeks of gestation were scheduled for this study. Half of them (50 women) were managed by labour induction (group A), while the other half (50 women) were treated expectantly (group B).
Every patient elegible for admission to this study was allotted serially a number from the table of random numbers, so all patients with even numbers induced labour (group A), and those with odd numbers received expectant management (group B).
The primary outcome was the presence or absence of neonatal respiratory distress syndrome as well as the mode of delivery, while the secondary outcome included neonatal sepsis, neonatal hypoglycaemia or neonatal hyperbilirubi-naemia.
Results: In the expectant group (B), neonatal sepsis was found in 9 cases (18%), neonatal respiratory distress syndrome was found in 8 cases (16%), neonatal hyperbilirvbnaemia was found in 5 cases (10%) and no reported cases of neonatal hypoglycemia. In the induction of labour group (A), no reported cases of neonatal sepsis, neonatal respiratory distress syndrome was found in 29 cases (58%), neonatal hyperbiliru-binaemia was found in 20 cases (40%) and neonatal hypogly-caemia was found in 18 cases (36%).
Conclusion: This current study showed that the expectant management in cases of premature prelabour rupture of membranes between 34 and the start of 37 weeks gestation remains the reasonable choice according to our local social and financial circumstances as regards the availability and cost of neonatal pediatric care units and medications needed for those preterm neonates.