Comparison of aggressive and conservative management of premature rupture of fetal membranes.

A 3-year prospective study was undertaken to compare two types of management of rupture of the fetal membranes between 26 and 34 weeks. Patients in whom amniotic fluid, obtained by amniocentesis, was shown to have no evidence of infection, and who had less than mature lecithin/sphingomyelin (L/S) ratios, were given steroids and, if needed, treated with tocolytic agents. Patients in whom no amniotic fluid could be obtained were not given steroids, but were managed expectantly. Only patients with rupture of membranes greater than or equal to 24 hours were included in the collection of data. Despite the aggressive treatment protocol of the steroid group, no significant difference was found between the two groups in the prevalence of respiratory distress, hyperbilirubinemia, patent ductus arteriosus, episodes of apnea and bradycardia, or necrotizing enterocolitis. Perinatal mortality rates were similar in the two groups, and no difference in the incidence of maternal or neonatal infectious complications was found.