ACTIVE EXPECTANT MANAGEMENT IN VERY EARLY GESTATIONS COMPLICATED BY PREMATURE RUPTURE OF THE FETAL MEMBRANES

Premature rupture of the membranes (PROM) in the previable gestation i s frequently associated with fetal or neonatal death. Passive expectan t management is successful in only II small minority of cases. Women p resenting with PROM at less than or equal to 27 weeks' gestation were treated with tocolysis and prophylactic antibiotics and delivered elec tively for lung maturity. The corrected perinatal survival was >92%. T he mean latency phase teas 21.6 days (+/- 18.12 SD). Twenty-one percen t of patients presented in. labor; the mean latency phase for this sub group was 14.4 (+/- 8.54) days. Nineteen patients (79%) had a latency phase >7 days, and 14 (58%) had a latency phase >4 days. Thirty-nine p ercent of infants required <48 hours of mechanical ventilation. Six in fants were delivered with intraventricular hemorrhage; in ail cases it teas grade I or 2. There were three (12.5%) postpartum infections and three septic neonates. Active expectant management using tocolysis an d prophylactic antibiotics was associated with a prolonged latency pha se, low infectious morbidity and good neonatal outcome.