PRETERM PREMATURE RUPTURE OF THE MEMBRANE S - CONTROVERSIAL MANAGEMENT AND INFECTION

Preterm premature rupture of the membranes is responsible for 40% of p reterm deliveries and the risks associated with prematurity override t hose associated with infection. However the diagnosis of chorioamnioni tis is usually suspected at an advanced stage and is therefore associa ted with a severe neonatal morbidity and mortality. The main controver sies include (i) conservative management as outpatients, (ii) amniocen tesis to seek for amniotic fluid infection, (iii) administration of co rticosteroids for fetal lung maturation, and (iv) tocolytics. The keys tone of these controversies is in evaluating the risk of intrauterine infection. Among the parameters reported in the literature to predict infection, some have a good predictive value (group 1) maternal pyrrhe xia over 38-degrees-C, positive microbiological examination of the amn iotic fluid retrieved by amniocentesis or by vaginal swab if B-strepto coccus, mycoplasma, Chlamydia or N. gonorrhoea are grown in culture. O thers have a lower predictive value (group 2) such as uterine contract ions, maternal C-reactive protein over 20 mG/L, low glucose concentrat ion in the amniotic fluid. Finally some parametres have little signifi cance on their own (group 3) vaginal bleeding, oligo-hydramnios, mater nal white cell count over 20,000/dL, intra-amniotic white cell count o ver 100/mL and a positive vaginal swab. Antibiotics should be given on ly when a high risk of infection is present. When the risk of respirat ory distress is low, there is no clear benefit with expectant manageme nt.