[Premature rupture of the fetal membranes--an active or expectant approach in management of this obstetrical problem].

INTRODUCTION

A prospective investigation and comparative analysis of clinical and microbiological results have been performed as to point to some facts of possible significance in solving the dilemmas concerning the problem of pregnant women with premature rupture of the membranes.

MATERIAL AND METHODS

Intensive clinical monitoring of the course, methods and complications of the labor was undertaken in 75 pregnant women with premature rupture of the membranes and term delivery. Smears from the vagina, cervix, amnion and amniotic fluid were obtained from each pregnant woman, as well as nasal and throat smears from newborn infants in order to microbiological analysis. According to the method of labor treatment, the investigated patients (n = 75) were distributed into 2 groups. Early induction of labor was applied in 39 pregnant women (labor induction 6 h following rupture of the membranes) and expectatively treated 37 pregnant women (the control of pregnant women until initiation of the spontaneous contractions associated with antibiotic prophylaxis).

RESULTS AND DISCUSSION

Duration of labor (period from rupture of the membranes to the delivery and from the initiation of regular contractions to the delivery) was significantly shorter (p < 0.01) in the induced labor group. Cesarean section was performed in 18.4% od labors in the first and in 13.5% of labors in the second group. Chorioamnionitis occurred in 7.9% in the first and in 21.6% in the second group during the labor (p < 0.05). The incidence of puerperal and neonatal infection was lower in the first investigated group (7.9% and 5.2%) than in the second group (18.9% and 16.2%). Positive microbiological finding was recorded in 13.2% of pregnant women from the first group and in 27.0% from the second group (p < 0.05).

CONCLUSION

From the medical point of view it is reasonable to apply early induction of labor in pregnant women at more than 34 weeks' gestation. In pregnant women of less than 34 weeks' gestation, the expectant management of labor is recommended only in the next 48-72 hours.