SURVIVAL AND 2-YEAR OUTCOME WITH EXPECTANT MANAGEMENT OF 2ND-TRIMESTER RUPTURE OF MEMBRANES

Objective: To evaluate the perinatal and 2-year outcomes in pregnancie s complicated by preterm premature rupture of membranes (PROM) during the second trimester. Methods: Fifty-three consecutive singleton pregn ancies with PROM at 14 to 28 weeks of gestation were studied retrospec tively. Management goals were to prolong the pregnancies to 32 weeks t hrough expectant management and to avoid fetal compromise through clos er monitoring and active intervention, when necessary, after 23 weeks. Outcome of the surviving infants was based on neurologic, audiometric , and ophthalmologic examinations at 2 years of corrected age. Results : Rupture of membranes occurred at 14-19 weeks (mean 17.4 weeks) in 10 women, at 20-25 weeks (mean 24.0 weeks) in 24, and at 26-28 weeks (me an 27.6 weeks) in 19. The median latency periods to delivery were 72 d ays, 12 days, and 10 days when rupture of membranes occurred at 14-19 weeks, 20-25 weeks, and 26-28 weeks, respectively. The overall inciden ce of chorioamnionitis was 28%. There were no fetal deaths and nine ne onatal deaths. When rupture of membranes occurred at 14-19 weeks, 20-2 5 weeks, and 26-28 weeks, the perinatal survival rates were 40%, 92%, and, 100%, respectively. Pulmonary hypoplasia accounted for seven deat hs. Of the live-born infants, 81% were alive at 2 years of corrected a ge. Survival without major impairment was observed in 75%, 80%, and 10 0% of the survivors when rupture of membranes occurred at 14-19 weeks, 20-25 weeks, and 26-28 weeks, respectively. Conclusion: Expectant man agement of second-trimester PROM offers better perinatal and long-term survival than previously thought. (Obstet Gynecol 1998;92:895-901. (C ) 1998 by The American College of Obstetricians and Gynecologists.).