Expectant management of preterm premature rupture of membranes and nonvertex presentation: what are the risks?

Autor: Lewis DF; Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, LA 71130-3932, USA. DLewi1@Lsuhsc.edu, Robichaux AG, Jaekle RK, Salas A, Canzoneri BJ, Horton K, Jaekle L, Stedman C
Jazyk: angličtina
Zdroj: American journal of obstetrics and gynecology [Am J Obstet Gynecol] 2007 Jun; Vol. 196 (6), pp. 566.e1-5; discussion 566.e5-6.
DOI: 10.1016/j.ajog.2007.02.023
Abstrakt: Objective: Preterm premature rupture of membranes (PPROM) continues to be a major cause of preterm births. The objective of this study was to compare the morbidity of patients with PPROM nonvertex presentations with patients with PPROM with vertex presentations.
Study Design: A retrospective analysis of data from 74 patients with PPROM with nonvertex presentations (study group) and 74 patients with PPROM with vertex presentations (control group) comprised the 2 study groups. All patients that met the study admission criteria were treated in a similar manner at 1 of 3 level-III hospitals. The gestational ages at delivery of all patients were between 23-34 weeks, and the gestational ages between case and control patients were matched for gestational age.
Results: A statistically significant (P = .03) higher incidence of a prolapsed umbilical cord was found in the study group (n = 8; 10.8%) relative to the control group (n = 1; 1.4%). More infants in the study group had low 5-minute Apgar scores (<5) and/or low cord pH (<7.20; n = 25 [33.8%]) than in the control group (n = 12 [16.2%]; P = .02). Five infants with breech presentations underwent a precipitous unplanned vaginal delivery. Significant morbidity was not detected in these 5 infants.
Conclusion: After transfer to an antenatal ward, patients with PPROM with nonvertex presentations appear to have a significantly higher risk for prolapsed umbilical cords, lower Apgar scores, and/or lower umbilical cord blood pH values, when compared with their vertex counterparts. Additionally, there appears to be substantial risk of an unintended, vaginal breech delivery.
Databáze: MEDLINE
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