Antepartum surveillance in preterm rupture of membranes.

The objective of this presentation is to describe noninvasive techniques of antepartum fetal assessment which allow the differentiation of fetuses who will benefit from remaining in-utero versus those who are at risk for intraamniotic infection and will benefit from your prompt delivery. The literature is reviewed in regard to the fetal biophysical profile, the effect of premature rupture of membranes (PROM), the usefulness of individual biophysical component in predicting intraamniotic infection (amniotic fluid volume, non-stress testing), the use of the fetal biophysical profile in improving pregnancy outcome, the relationships among umbilical artery velocimetry, fetal biophysical profile and intraamniotic infection and the mechanisms by which infection diminishes fetal biophysical activities in PROM. After reviewing our own as well as the published experience with the use of fetal biophysical assessment in patients with PROM, the following conclusions are suggested: a) most studies have shown strong correlation between abnormal biophysical assessment and infection outcome (maternal and/or neonatal infection) as well as intraamniotic infection, if there is frequent (i.e. daily) testing; and b) fetal biophysical tests (profiles, NSTs, amniotic fluid volume determinations) are quite reliable in predicting the well fetus who can safely remain in-utero and also the fetus who is at high risk for developing neonatal sepsis. A protocol for management of preterm PROM will be outlined based upon frequent (daily) fetal biophysical assessment. Although there are no controlled randomized trials to support that pregnancy outcome is improved by the use of frequent biophysical assessment, non-randomized studies as well as studies with historic controls suggest that the use of frequent biophysical assessment is beneficial in managing patients with PROM.