Conservative management of preterm premature rupture of the fetal membranes in a low socioeconomic population.

The management of rupture of the membranes associated with a premature gestation (PROM) is controversial. Some authors advise immediate delivery while others counsel delay in the hope of decreasing the morbidity and mortality rates associated with prematurity. A retrospective chart review of 90 pregnancies with this obstetric complication treated conservatively was performed to delineate the relative risk factors in a low socioeconomic population. All patients were placed at bed rest until either labor or amnionitis prompted delivery. Amnionitis was a significant problem, occurring in 27% of patients. The percentage of women developing amnionitis did not increase with increasing duration of PROM. Respiratory distress syndrome (RDS) was the significant cause of neonatal illness and death. No relationship between the duration of PROM and incidence of RDS could be demonstrated, but there was a significant relationship between birth weight and RDS. The smaller the infant, the more likely it would be to develop RDS. Our data indicate that a possible course of therapy would be to accelerate fetal lung maturity medically and then deliver the infant. A randomized prospective study could answer this question.