The role of continuous fetal monitoring in the management of preterm premature rupture of membranes.

OBJECTIVE

Continuous fetal monitoring (CFM) is often used in the management of preterm premature rupture of membranes (PPROM) but there is little evidence to support this approach. The objective of this study was to evaluate the clinical outcome of PPROM when managed by CFM.

METHODS

A retrospective review was conducted of 129 cases PPROM outcomes for the period January 1, 1998 to December 31, 2003. All women underwent CFM. Delivery was carried out for non-reassuring fetal testing, vaginal bleeding, evidence of infection, positive vaginal pool phosphatidylglycerol when available, and spontaneous labor.

RESULTS

Delivery was carried out because of an abnormal fetal heart tracing in 15 women (11.7%). The mean gestational age at admission was 32.2 weeks (95% CI 31.7-32.7), the mean gestational age at delivery was 32.7 weeks (95% CI 32.2-33.1), and the mean latency period was 3.3 days (95% CI 1.5-5.0). Gestational age at rupture of membranes was inversely correlated with latency period (n = 128, r = -0.372, p < 0.001). With regard to gestational age, gravidity, and latency period there was no significant difference noted with respect to why the subjects delivered. No intrauterine deaths occurred in the study.

CONCLUSION

In our series, fetal heart rate tracing abnormalities were the indication for delivery in a small but significant percentage of conservatively managed PPROM cases. Our review suggests that a prospective trial of CFM versus intermittent monitoring techniques should be carried out.