Preterm prelabour rupture of the membranes before 28 weeks: better than feared outcome of expectant management in Africa.

OBJECTIVE

To document the prognosis after conservative management of patients with membrane rupture at gestations less than 28 weeks.

STUDY DESIGN

Prospective observational study of 78 women with confirmed membrane rupture at less than 28 weeks gestation, managed conservatively. Antibiotics were given from the time of membrane rupture till delivery. Patients were delivered if clinical infection supervened, there was fetal compromise, spontaneous labour ensued or if the pregnancy continued to 34 completed weeks gestation.

RESULTS

The mean gestational age at membrane rupture was 23.3+/-3.17 weeks (16.5-27.8) and the median 24 weeks. Mean latency period was 24.1+/-29.1 days (1.5-154) with a median of 12.5 days. Eight women (10%) delivered between 24 and 48 h, 25 (32%) within 7 days and 55 (70%) within 1 month. Of note is that 23 patients (30%) had latency periods of greater than 1 month. The mean gestational age at delivery was 26.7+/-3.92 weeks. Overall of the 78 women there were 81 fetuses delivered, of which 35 (43%) survived. Survival was related to latency period, birth weight and gestational age at delivery. Sixteen women (20%) developed chorioamnionitis. There was no increase in the incidence of clinical infection with increasing latency period. Compression limb abnormalities occurred in 17% of neonates and lung hypoplasia in 18%.

CONCLUSION

Conservative management of patients with very preterm prelabour membrane rupture offers a survival rate of at least 40% with no serious complications in a study of 78 women.