Treatment of premature rupture of the membranes.

Few topics in obstetrics are debated more widely than the treatment of premature rupture of the fetal membranes (PROM). Over a two-year period, a retrospective analysis of 422 patients with that diagnosis revealed 86 mother-infant pairs at less than 37 weeks of gestation acceptable for review as it pertained to expectant or conservative management. The gestational age in these patients ranged from 26 to 36 weeks, with a mean of 31.9. Using the conservative management approach, 12% of the patients developed amnionitis during the antepartum period, and febrile morbidity was noted postpartum in eight patients. The neonatal outcome revealed a 14% incidence of respiratory distress syndrome (RDS). There were 18 infants with suspected sepsis, but of the 6 cases of proven infection, only 1 was related to amnionitis. Ten of the 12 infants contracting RDS were males, reflecting a reversal of the sex ratio found in those who did not develop RDS. The sex difference in the offspring was found to favor females with respect to RDS, even greater than 48 hours after rupture of the membranes. These data demonstrate that with the use of expectant management in patients with PROM at 26-36 weeks of gestation, there was no dramatic increase in maternal or neonatal infections.