G. Decavalas et al., SHORT-TERM VERSUS LONG-TERM PROPHYLACTIC TOCOLYSIS IN PATIENTS WITH PRETERM PREMATURE RUPTURE OF MEMBRANES, European journal of obstetrics, gynecology, and reproductive biology, 59(2), 1995, pp. 143-147
A randomised prospective clinical trial was conducted over a 7-year pe
riod (1987-1993) in the Department of Obstetrics and Gynaecology, Univ
ersity of Patras. The purpose of this study was to compare two managem
ent protocols of Preterm Premature Rupture of Membranes (PPROM). Two-h
undred forty-one women entered the study and were assigned randomly to
one of two groups. Group A consisted of 105 subjects who were managed
expectantly (tocolysis used for 48 h only, if necessary, to permit fu
ll course of steroid therapy), while Group B consisted of 136 subjects
, in whom aggressive tocolysis was utilised. The differences in the la
tency period (time from rupture of membranes to the onset of labour) w
ere not statistically significant between the two groups. On the contr
ary, statistically significant differences in the incidence of chorioa
mnionitis and postpartum endomyometritis were found between the two gr
oups (higher in Group B). Twelve subjects in Group A (12/105, 11.4%) a
nd 40 in Group B (40/136, 29.4%) had choriamnionitis. The relative ris
k (RR) was 2.47 (95% C.I. 1.42-4.66, P < 0.001). Endomyometritis was d
iagnosed in 20 subjects in Group A (20/105, 19%) and in 45 in Group B
(45/136, 33.3%). The RR was 1.74 (95% C.I. 1.10-2.75, P < 0.05). These
data suggest that long term prophylactic tocolytic therapy in patient
s with PPROM, while without demonstrated benefit, may result in an inc
reased risk of maternal infectious morbidity, and raise the cost of tr
eatment.