Prolapsed fetal membranes in the second trimester: A retrospective comparison of expectant vs. surgical management

Objective: The optimal management of prolapsed fetal membranes in the secon d trimester is unclear. We compared the results of expectant management and surgery and tried to identify risk factors for the occurrence of prolapse of the fetal membranes and prognostic factors to predict the outcome of tre atment. Methods: We reviewed the records of 94 women admitted for prolapsed fetal m embranes between 13 and 26 weeks' gestation from December 1989 to April 199 9 and examined data from the Berlin Perinatal Database to identify risk fac tors and prognostic factors. Results: A total of 76 patients were included in the study. Fifty-eight pat ients were treated expectantly (bed rest, tocolysis, antibiotics) and 18 un derwent cervical closure, cerclage, or both. The median duration of pregnan cy after presentation was 3 days with expectant management and 29 days with surgery. Live births occurred with 29 and 56% of cases (P=0.04) and the me dian weight of the live-born neonates was 750 g and 900 g, respectively (P= 0.03). Conclusion: In this series surgical treatment was superior to expectant man agement for amniotic sac prolapse in the second trimester. Amniotic sac pro lapse was more frequent with multiple pregnancy and in patients with a hist ory of premature separation of the placenta, spontaneous abortion or coniza tion. Increasing degree of prolapsed membranes, signs of infection, and a h istory of elective abortion were associated with a poor outcome in patients treated expectantly. In patients treated with surgery, low body mass was a ssociated with a favorable outcome.