Document Detail


Perinatal outcome following conservative management of mid-trimester pre-labour rupture of the membranes.
MedLine Citation:
PMID:  9145355     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess perinatal outcome and the effect of antenatal steroid use following conservative management of 86 consecutive singleton pregnancies complicated by pre-labour rupture of membranes (ROM) in the mid-trimester (13-26 weeks; mean 22.8 weeks). METHODOLOGY: Review of obstetric and neonatal case notes between 1 January 1990 and 31 December 1993. RESULTS: The duration of ruptured membranes (latent period) ranged from 1.25 to 105 days (mean 23.8 days; median 14 days) and was inversely related to gestational age at ROM. There was clinical evidence of chorioamnionitis in 39.5% with placental histological changes consistent with chorioamnionitis in 76.6%. All infants were delivered before 33 weeks gestation (mean 26 weeks). Overall, the mortality rate was 43.0% but 62.5% in infants with ROM before 24 completed weeks gestation. Adverse outcome (defined as death, severe intraventricular haemorrhage (IVH) or periventricular leucomalacia (PVL)) occurred in 46.5% and was significantly related to both gestation at delivery and gestation at ROM. In the group (n = 40) with ROM before 24 weeks gestation, adverse outcome occurred in 65% and was inversely related to gestation at ROM independent of gestation at delivery. Antenatal steroid administration resulted in less adverse outcome independent of gestation at delivery (OR 0.31; 95% CI (0.09-0.98; P = 0.046)). CONCLUSION: From the neonatal perspective conservative management is justified for pregnancies with ROM at or after 24 weeks gestation; in this group the use of antenatal steroids prior to delivery may improve perinatal outcome. A poor outcome is associated with ROM that occurs before 24 weeks gestation.
Authors:
C B Nourse; P A Steer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of paediatrics and child health     Volume:  33     ISSN:  1034-4810     ISO Abbreviation:  J Paediatr Child Health     Publication Date:  1997 Apr 
Date Detail:
Created Date:  1997-07-30     Completed Date:  1997-07-30     Revised Date:  2007-09-24    
Medline Journal Info:
Nlm Unique ID:  9005421     Medline TA:  J Paediatr Child Health     Country:  AUSTRALIA    
Other Details:
Languages:  eng     Pagination:  125-30     Citation Subset:  IM    
Affiliation:
Department of Neonatology, Mater Mothers' Hospital, Annerley, Queensland, Australia.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Age Factors
Cerebral Hemorrhage / epidemiology,  etiology
Chi-Square Distribution
Confidence Intervals
Female
Fetal Membranes, Premature Rupture / complications,  mortality,  therapy*
Gestational Age
Humans
Infant, Newborn
Leukomalacia, Periventricular / epidemiology,  etiology
Odds Ratio
Perinatal Care / methods,  standards*
Pregnancy
Pregnancy Outcome
Queensland / epidemiology
Regression Analysis
Respiratory Tract Diseases / epidemiology,  etiology
Retrospective Studies
Steroids / therapeutic use*
Tocolysis / standards*
Chemical
Reg. No./Substance:
0/Steroids

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