Prospective randomized study of corticosteroids in the management of premature rupture of the membranes and the premature gestation.

A prospective randomized study involving patients with premature rupture of the membranes between the twenty-eighth week and the thirty-fourth week of pregnancy was conducted. Patients with chorioamnionitis, advanced labor, and fetal distress, as well as those with mature lecithin/sphingomyelin ratios and/or Gram stains positive for bacteria, were delivered immediately. The remaining patients were randomized. One group received betamethasone. Tocolytic agents were used in this group when necessary. After 48 hours all patients given corticosteroids (CS group) were delivered). The second group was managed expectantly (EM group) and were delivered only when spontaneous labor or infection occurred. A total of 160 patients were randomized, 80 in each group. Maternal outcome, including chorioamnionitis and cesarean section rates, was not different; however, the endometritis rate was significantly higher in the CS group (p less than 0.05). Neonatal outcome did not differ in mean birth weights, perinatal death rates, neonatal infections, or incidences of respiratory distress. The frequency of prolonged hospital stay (greater than 4 weeks) was higher in the neonates in the CS group (p less than 0.01). The conclusion is that corticosteroids and active management in patients with premature rupture of the membranes and premature gestations do not decrease the incidence of respiratory distress syndrome or perinatal mortality and may aggravate certain infectious complications.