The natural history of preterm ruptured membranes: what to expect of expectant management.

We asked the question: What can be expected of expectant management in preterm ruptured membranes? Our findings showed that ruptured membranes during the first half of the third trimester occurred in only 1.7% (N = 298) of 17,877 pregnancies delivered at our institution, yet accounted for 20% of the total perinatal deaths during the study period. Expectant management was seldom successful; only 20 (7%) of pregnancies with preterm ruptured membranes did not begin labor within 48 hours. The condition of preterm ruptured membranes was also frequently associated with other obstetric complications such as twins, breech presentation, chorioamnionitis, and fetal heart rate decelerations in labor. We conclude that preterm ruptured membranes is an uncommon but complex obstetric problem that remains largely unsolved.