Pulmonary Maturation in Preterm Rupture of Membranes with Oligohydramnios

Does residual amniotic fluid after preterm premature rupture of membranes have an effect on perinatal outcomes? 12 years experience of a tertiary care center

OBJECTIVE

To review our experience with preterm premature rupture of membranes at a tertiary-care hospital in Turkey to determine whether the amount of residual amniotic fluid after rupture has prognostic value for adverse maternal and fetal outcomes.

METHODS

We reviewed the medical records of 191 pregnant women with gestational ages between 24 and 34 weeks at the time of rupture of the amniotic membrane and of their babies delivered in our hospital between January 1996 and September 2008. On the basis of amniotic fluid index (AFI) values recorded at the time of admission, patients were categorized into two groups: those with an AFI < 50 mm (n = 119) and those with an AFI > 50 mm (n = 72).

RESULTS

The patients with high gravidity (4-8) were more prevalent in the group with an AFI < 50 mm (37 vs. 23.6%), while nulliparous women were more common in the group with an AFI > 50 mm (44.4 vs. 30.2%) (P < 0.05). Seventy-two percent of the cesarean sections performed due to nonreassuring fetal status were in the group with an AFI < 50 mm (P < 0.01). In 71.4% of the cases with a 5 min Apgar score < or = 7, AFI was less than 50 mm (P < 0.01). AFI < 50 mm was present in 65, 70.8, 76.7, and 73.1% of the pregnancies complicated by chorioamnionitis, respiratory distress syndrome, composite neonatal morbidity, and neonatal death, respectively (P < 0.05).

CONCLUSIONS

A residual AFI < 50 mm after preterm PROM between 24 and 34 weeks of gestation, which is mostly seen in grand multiparous women in Eastern Turkey, may be a valuable prognostic variable for anticipating adverse maternal and neonatal outcomes.