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Objective: We sought to evaluate whether serial amnioinfusions for persistent oligohydramnios can affect the perinatal and long-term outcomes in extreme cases of preterm premature rupture of membranes. Study Design: All singleton pregnancies with preterm premature rupture of membranes at 4 days between January 1991 and December 2001 were included. Amniotic fluid volume was assessed as the maximum cord-free pocket with serial ultrasonographic examinations. Consenting women with persistent (>4 days) oligohydramnios (amniotic fluid=2 cm) received serial transabdominal amnioinfusions to maintain an amniotic fluid pocket >2 cm. The pregnancy, neonatal, and long-term neurologic outcomes of the cases that spontaneously maintained a median amniotic fluid pocket >2 cm were compared with those of women with oligohydramnios who underwent amnioinfusion but continued to have persistent oligohydramnios and with those of women in whom oligohydramnios was alleviated. Statistical analysis included the Wilcoxon rank-sum test and the Fisher exact test with a 2-tailed P2 cm for =48 hours in 11 (30%) patients. This successful amnioinfusion group was comparable with the persistent oligohydramnios group (n=25) in gestational age at first amnioinfusion (median, 20.2 weeks; range, 16-25.6 weeks; vs median, 20.3 weeks; range, 16.5-24.2 weeks; P=.4), number of amnioinfusions (median, 3; range, 1-9; vs median, 3; range, 1-5; P=.4), and interval between amnioinfusions (median, 6 days; range, 4-14 days; vs median, 8 days; range, 6-43 days; P=.1). However, patients in the persistent oligohydramnios group had a significantly shorter interval to delivery, lower neonatal survival (20%), and higher rates of pulmonary hypoplasia (62%) and abnormal neurologic outcomes (60%) than the patients in the groups in which amnioinfusion was not necessary or was successful (all P=.01). Logistic regression analysis demonstrated that after taking into consideration successful amnioinfusion (P=0.019) and administration of steroids (P=0.022), none of the other variables, including gestational age at delivery, contributed significantly to the prediction of perinatal survival in the persistent oligohydramnios group. Conclusion: Pregnancies with preterm premature rupture of membranes-related oligohydramnios at |
