Spontaneous Premature Rupture of the Membranes

Abstract

Summary: Sixty patients with premature rupture of the membranes occurring between 26 and 37 weeks of gestation who were not in labour 48 hours later were studied prospectively. There were 12 perinatal deaths (20%). The average prolongation of pregnancy with a regime of strict bed rest was 14 days. This regime was considered preferable to one of active intervention, since the perinatal loss from infection was offset by the gain resulting from increased maturity. Progestogen therapy in the doses used was ineffective in postponing the onset of labour. Four perinatal deaths were associated with infection: in one infant a significant infection in the vagina caused a neonatal pneumonia, in another infant the pneumonia was acquired by transplacental infection, whilst in the other 2 infants the portal of entry of the infection was not demonstrated. Serial vaginal bacteriological smears and white cell counts were usually of no assistance in detecting the foetus at risk. Induction of labour in selected instances is not practicable in the absence of some means of detecting the foetus at risk. No such means of detection became apparent in this study.