Extreme prematurity or pulmonary hypoplasia: The inevitable consequences of second trimester premature rupture of membranes?

P. J. Robson, M. Smid, S. Bannerjee, J. S. Wigglesworth, U. Nicolini

Research output: Contribution to journalArticlepeer-review

Abstract

Seventy-nine patients were admitted not in labour during 1981 -1989 with the diagnosis of ruptured membranes at less than 28 weeks gestational age. All remained in hospital until delivery. Use of antibiotics, tocolytics, steroids and the choice of the mode of delivery were left to the discretion of the individual consultant. Thirty per cent of patients had a previous obstetric history of preterm rupture of the membranes, second trimester abortions or preterm deliveries. Cervical cir-clage or invasive procedures had been performed during the index pregnancy in 24 per cent. Median gestational age at admission was 25 weeks and the median interval to delivery was 12 days. There was a negative correlation between gestational age when the membranes ruptured and interval to delivery (r = - 0.74, P <0.0001). Amnionitis was diagnosed in 44 per cent. Overall fetal survival was 56 per cent. Steroids appeared to improve survival, whereas the rate of cae-sarean section was similar in survivors and neonatal deaths. Outcome was not influenced by maternal age, race, socio-economic status, smoking, previous obstetric history or presentation at delivery. Relevant variables were gestational age at rupture of membranes, interval from membrane rupture and gestational age at birth, whereas no effect was evident for mode of delivery. Multivariate analysis showed that the best prediction of outcome was achieved by the combination of birth weight, interval to delivery and fetal sex. Of the 34 babies who survived and were followed up, four had major physical or neurological handicaps. Of the 13 fetuses and newborn who had a postmortem examination, 11 had lung hypoplasia or dysplasia. Whilst prolonged intervals from rupture of membranes to delivery enhance the prospects of developmental maturity, they also increase the risk of pulmonary hypoplasia.

Original languageEnglish
Pages (from-to)320-328
Number of pages9
JournalJournal of Obstetrics and Gynaecology
Volume13
Issue number5
DOIs
Publication statusPublished - 1993

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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