Premature rupture of membranes (PROM) in very low birth weight infants (VLBWI) - Results of expectant management

Purpose: Premature rupture of membranes (PROM) <32 weeks can be managed act ively with prompt induction of delivery or expectantly. Material and Methods: Of 425 deliveries < 32 weeks of gestation 278 were de livered with rupture of membranes (ROM) <12 hours, 47 with FROM 12-48 hours , and 100 with FROM <48 hours (2-44 days) before delivery. The duration of latency the period between ROM and delivery (< 12 h vs. >48 h) had no influ ence on the rate of Apgar(5)scores less than or equal to 7 (17% vs.16%), ar terial cord blood pH < 7.10 (7% vs. 2 %), respiratory distress syndrome (RD S) (45% vs. 49%), intraventricular haemorrhage (IVH) (22% vs. 26%), need fo r artificial Ventilation > 1 week (34% vs. 37 %), traumatic haematomas (15% vs. 9%) or severe infections such as sepsis (8% vs. 9%) or pneumonia (7 % vs. 8%). Results: With a latency period of >48 hours less than half of prematures (8 % vs. 19%, p <0.006) died neonatally compared with those delivered promptly . At FROM less than or equal to 26(th) week and a mean gain of 9 days neona tal mortality was 23% lower than in promptly delivered offspring (20% vs. 4 3%, p <0.03). The Caesarean section Fate was significantly lower (38% vs. 5 0%, p=0.05) with prolonged latency period. The rates of IVH (R=0.98, p <0.0 02), RDS (R=0.99, p <0.02), traumatic haematoma (R=0.96, p<0.02), neonatal infection (R=0.96, p<0.04) and duration of ventilation (R = 0.46, p < 0.001 ) decreased significantly with advancing gestational age. Conclusion: We conclude that in FROM before 32 weeks expectant management a nd prolongation of pregnancy is indicated if there are no maternal (amnion infection disease) or fetal (fetal distress) contraindications.