Active management of the premature membrane rupture in pregnancies of 34 to 37 weeks

Departamento Clínico de Perinatología, Hospital de Ginecología y Obstetricia Numero 3.
Ginecología y obstetricia de México 06/2006; 74(5):252-9.
Source: PubMed


Premature rupture of membranes is considered an obstetrical emergency since it has been associated with an increment of sepsis and maternal-fetal morbidity. For this reason, controversy exists among conservative and active management for the obstetrical resolution.
To determine if active management of premature rupture of membranes in pregnancy of 34 to 37 weeks diminishes the cesarean section incidence and the maternal-fetal morbidity.
Two groups of patients with pregnancy of 34 to 37 weeks and premature rupture of membranes were compared. Group I with active management was integrated by 42 cases that initiated inductoconduction at their admission to the hospital, and in group II, with 26 cases on the conservative management, medication was used to induce fetal pulmonary maturity and spontaneous delivery was expected. Descriptive statistics was carried out by means of the statistical package SPSS-10.
The mean age of the patients was 27.2 +/- 5.8 years. Pregnancy resolution within the first 12 hours was 23.8% in group I and 11.5% in group II. Cesarean section in group I was made in 28.5% of the cases and in group II in 65.3% of them (p < 0.05). The most common indication for cesarean section in group I was stationary labor (16.5%) and in group II unfavorable cervical conditions (26.9%). Maternal and newborn hospital stay was greater in group II (p < 0.01). The most frequent maternal complication in both groups was decidual infection, with 4.7 and 15.3%, respectively. General maternal and neonatal morbidity was greater in group II.
Conservative management of premature rupture of membranes, when pregnancy is equal or greater than 34 weeks, does not offer fetal benefits, increases the incidence of cesarean sections, the hospital stay and the cost of the medical attention.

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