SHORT-TERM VERSUS LONG-TERM PROPHYLACTIC TOCOLYSIS IN PATIENTS WITH PRETERM PREMATURE RUPTURE OF MEMBRANES

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.