PRETERM PREMATURE RUPTURE OF MEMBRANES AND THE ASSOCIATED RISK FOR PLACENTAL ABRUPTION - INVERSE CORRELATION TO GESTATIONAL LENGTH

Objective. To evaluate the association between prolonged premature rup ture of membranes (FROM) and placental abruption, especially during mi dtrimester pregnancy. Methods. A retrospective hospital based study of 83 women with FROM occurring between 14 and 32 weeks of gestation and where active expectant management was undertaken. Results. Increased frequency of placental abruption was found in patients with early rupt ure of membranes. The incidence was 50% and 44% when rupture of the me mbranes occurred before 20 weeks or between 20-24 weeks of pregnancy, respectively. When FROM occurred during gestational ages of 29-32 week s, the incidence was 13%. Patients with antepartum bleeding, both befo re (relative risk 34) and after rupture of the membranes (relative ris k 38) had a significantly higher risk for placental abruption (p<.001) than women without bleeding prior to delivery The overall neonatal su rvival rate was 87%. No neonatal deaths were considered to be directly caused by asphyxia due to placental abruption. Conclusion. Using acti ve expectant management and strict routines it seems possible to minim ize the risk for perinatal asphyxia and mortality The clinician should be aware of the significant association between preterm premature rup ture of membranes and the risk for subsequent placental abruption, esp ecially in patients with early midtrimester FROM and history of bleedi ngs before rupture of membranes or bleedings during the latency period .