THE CERVICAL-CAP - REACCUMULATION OF AMNIOTIC-FLUID DOES NOT IMPROVE PERINATAL OUTCOME

Objectives: We investigated the safety and efficacy of the cervical ca p in restoring amniotic fluid volume in previable pregnancies complica ted by premature rupture of membranes and oligohydramnios. Methods: Pa tients with premature rupture of membranes <24 weeks' gestation and an amniotic fluid index <5 cm were candidates for cap placement if they desired expectant management and had no clinical signs of intrauterine infection or vaginal bleeding. Results: The cervical cap was applied in four pregnancies. Amniotic fluid reaccumulated in all pregnancies a nd the mean amniotic fluid index increased from 0 to 5.8 +/- 2.8 cm. T he first two pregnancies, however, resulted in neonates that expired f rom pulmonary hypoplasia. The third pregnancy was electively terminate d because of our inability to assure prevention of pulmonary hypoplasi a. The fourth pregnancy was terminated secondary to an intrauterine fe tal demise. Conclusion: These observations disappointingly suggest tha t in spite of modest reaccumulation of amniotic fluid after midtrimest er premature rupture of membranes, perinatal outcome may not be improv ed.