PREMATURE RUPTURE OF THE FETAL MEMBRANE - PROBLEMS AND OBSTETRIC MANAGEMENT

The treatment of a premature rupture of the foetal membrane (prom) has up to now been a subject of controversy. Depending on the stage of ge station, the prompt birth ensuing as a result of prom, involves the ri sk of immaturity of the child. Conservative waiting by contrast, expos es mother and child to a potential risk of infection. The retrospectiv e study presented, summarises the strategies for treating prom used at the Cologne University Department of Obstetrics and Gynaecology durin g the period from 1984 to 1989, and attempts to develop from these dat a proposals for the treatment of prom. With an increase in latency of over 24 hours between prom and delivery, the maternal and neonatal rat e of infection also increased significantly. An effective result of a prophylaxis with antibiotics could only be shown in the reduction of i ncidence of infection in the mother. An effect on the neonatal rate of infection could not be seen. Inducing prepartually lung-maturity with glucocorticoides or ambroxol resulted in a significant decrease of th e RDS-rate in new born children up to the 34th week of gestation. Beyo nd the 34th week of gestation, this effect could not be found. Whereas after completion of the 37th week of gestation, the preferred treatme nt used by doctors is allowing the shortest possible time of latency b etween prom and delivery, the expected pulmonary immaturity before the 34th week of gestation has to be treated by prolonging the pregnancy and inducing pulmonary maturity under antibiotic prophylaxis and at th e same time controlling infection. The time-period between the 34th an d 37th weeks of gestation requires individualised treatment, whereby a significant rise in the inflammation parameter should be the reason f or immediate termination of the pregnancy.