Actualities in the therapeutic approach of preterm and premature rupture of membranes

R. Bohîlțea, N. Turcan, C. Berceanu, Ș. Nastasia, I. Ducu, M.M. Cîrstoiu

Rezumat: Preterm and premature rupture of fetal membranes (PPROM) refers to membrane rupture before 37 weeks of gestation in the absence of labor. The frequency of association with premature birth is about 1/3 and the incidence in pregnant women is 3%. Under the conditions of lack of infection and under continuous antibiotic prophylaxis, the expectant management can prolong the pregnancy by about one week, the duration of prolongation being inversely proportional to the gestational age. For 14% of pregnancies at the viability limit, less than 24 weeks of gestation, complicated by membrane rupture, fluid loss will be self-limiting due to “restoring membrane integrity” by changes of the decidua and of the myometrium. A number of associated factors significantly affect the prognosis of these cases, namely: gestational age, presence or absence of fetal or maternal infection, presence of uterine contractions, fetal presentation, fetal status, fetal lung maturity, cervical status and maternity status. The reference decision in order to obtain the most favorable prognosis in the short and long term is the expectant approach or labor induction/ caesarean delivery. Expectant management implies an increased risk of intrauterine infection, abruptio placentae and umbilical cord prolapse. The administration of corticosteroids in pregnancies between 24 and 34 weeks with PPROM aims to reduce neonatal death by respiratory distress syndrome, intraventricular hemorrhage, ulceronecrotic enterocolitis, and the need for ventilator support. Birth within the first 48 hours of presentation without being required by emergency obstetric conditions may be considered after counseling the future parents about the prognosis of premature delivery and after corticosteroid cure was applied for pulmonary maturation corresponding to pregnancy smaller than 34 weeks.The preferential approach of these cases, applied by the authors, is the expectant management respecting the above mentioned principles, which, observationally, provide a superior prognosis. The comparative retrospective analysis of both neonatal and maternal characteristics of pregnancies with PPROM supports the maximal possible prolongation of the evolution of pregnancies complicated with PPROM.
Cuvinte cheie: PPROM, expectant management, chorioamnionitis