Premature rupture of the fetal membranes during premature pregnancy. Management: reality and prospects

Premature rupture of the fetal membranes is a complication of pregnancy, causing premature labour and birth of a premature newborn. Premature birth rate consist of 6 to 12%.

MATERIALS AND METHODS: We perform a retrospective analysis of 71 cases of patients with a premature rupture of the fetal membranes with active and expectant management and perinatal outcomes. The 1st group consisted of 19 patients with a gestation age of 22–28 weeks, the 2nd group ― 52 patients with a gestation age of 29–34 weeks.

RESULTS: The duration of the period between rupture of membranes and delivery in patients of the first group (22–28 weeks) was: up to 48 hours ― 3 patients, 48 hours – 14 days ― 15 patients, more than 14 days ― 1 patient. In patients of the second group (29–34 weeks), respectively: up to 48 hours ―17 patients, 48 hours – 14 days ― 30 patients, more than 14 days ― 5 patients. The duration of expectant management for PRFM in premature pregnancy is determined by the duration of pregnancy, the condition of the mother of the fetus, the presence of clinical and laboratory signs of chorioamnionitis, the amount and changing of the volume of amniotic fluid. The management of prolongation preterm pregnancy led to the fact that the gestational age at the time of delivery compared to the time of hospitalization significantly increased. In the group of patients, 22–28 weeks gestation, the increase averaged 6.7 days, the maximum increase was 25 days, in the group of patients 29–34 weeks gestation, the increase averaged 6.8 days, the maximum increase in gestational age was 35 days.

CONCLUSION: The expectant management of premature pregnancy in PRFM allows to increase the gestational age (by an average of 6.8 days), to increase the weight of the fetus, to reduce perinatal mortality, to reduce the need for prematures in mechanical ventilation by more than half, to ensure a high level of discharge of newborns home.