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. 1988 Oct;63(10 Spec No):1146–1150. doi: 10.1136/adc.63.10_spec_no.1146

Neonatal outcome after prolonged rupture of the membranes starting in the second trimester.

M Blott 1, A Greenough 1
PMCID: PMC1590218  PMID: 3196069

Abstract

The neonatal outcomes of 30 pregnancies that were complicated by premature and prolonged rupture of the membranes that had started in the second trimester of pregnancy, were reviewed. The neonatal mortality was 11 (36%), the main cause of death being pulmonary hypoplasia. Two infants died of sepsis, but these were the only proved episodes of maternal or fetal infection. Of the survivors, 27% developed compressive limb abnormalities, all of which responded to passive physiotherapy. Pulmonary hypoplasia was significantly associated with earlier onset of rupture of the membranes, and the absence of fetal breathing movements. Compressive limb abnormalities were significantly associated with longer periods of oligohydramnios. We conclude that premature rupture of the membranes, even with onset in the second trimester, may be associated with a favourable outcome and this may be predicted by the persistence of fetal breathing movements. We therefore, recommend expectant management of such pregnancies, but suggest elective delivery at 34 weeks to limit fetal exposure to uterine compression and minimise the risks of prematurity.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adzick N. S., Harrison M. R., Glick P. L., Nakayama D. K., Manning F. A., deLorimier A. A. Diaphragmatic hernia in the fetus: prenatal diagnosis and outcome in 94 cases. J Pediatr Surg. 1985 Aug;20(4):357–361. doi: 10.1016/s0022-3468(85)80219-0. [DOI] [PubMed] [Google Scholar]
  2. Askenazi S. S., Perlman M. Pulmonary hypoplasia: lung weight and radial alveolar count as criteria of diagnosis. Arch Dis Child. 1979 Aug;54(8):614–618. doi: 10.1136/adc.54.8.614. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blott M., Greenough A., Nicolaides K. H., Moscoso G., Gibb D., Campbell S. Fetal breathing movements as predictor of favourable pregnancy outcome after oligohydramnios due to membrane rupture in second trimester. Lancet. 1987 Jul 18;2(8551):129–131. doi: 10.1016/s0140-6736(87)92332-4. [DOI] [PubMed] [Google Scholar]
  4. Daikoku N. H., Kaltreider D. F., Khouzami V. A., Spence M., Johnson J. W. Premature rupture of membranes and spontaneous preterm labor: maternal endometritis risks. Obstet Gynecol. 1982 Jan;59(1):13–20. [PubMed] [Google Scholar]
  5. Fantel A. G., Shepard T. H. Potter syndrome. Nonrenal features induced by oligoamnios. Am J Dis Child. 1975 Nov;129(11):1346–1347. doi: 10.1001/archpedi.1975.02120480060015. [DOI] [PubMed] [Google Scholar]
  6. Gunn G. C., Mishell D. R., Jr, Morton D. G. Premature rupture of the fetal membranes. A review. Am J Obstet Gynecol. 1970 Feb 1;106(3):469–483. doi: 10.1016/0002-9378(70)90378-9. [DOI] [PubMed] [Google Scholar]
  7. Kilbride H. W., Thibeault D. W., Yeast J., Maulik D., Grundy H. O. Fetal breathing is not a predictor of pulmonary hypoplasia in pregnancies complicated by oligohydramnios. Lancet. 1988 Feb 6;1(8580):305–306. doi: 10.1016/s0140-6736(88)90394-7. [DOI] [PubMed] [Google Scholar]
  8. Manning F. A., Platt L. D. Fetal breathing movements and the abnormal contraction stress test. Am J Obstet Gynecol. 1979 Mar 15;133(6):590–593. doi: 10.1016/0002-9378(79)90002-4. [DOI] [PubMed] [Google Scholar]
  9. Manning F. A., Platt L. D., Sipos L. Antepartum fetal evaluation: development of a fetal biophysical profile. Am J Obstet Gynecol. 1980 Mar 15;136(6):787–795. doi: 10.1016/0002-9378(80)90457-3. [DOI] [PubMed] [Google Scholar]
  10. Moessinger A. C., Collins M. H., Blanc W. A., Rey H. R., James L. S. Oligohydramnios-induced lung hypoplasia: the influence of timing and duration in gestation. Pediatr Res. 1986 Oct;20(10):951–954. doi: 10.1203/00006450-198610000-00012. [DOI] [PubMed] [Google Scholar]
  11. Moessinger A. C., Fox H. E., Higgins A., Rey H. R., Haideri M. A. Fetal breathing movements are not a reliable predictor of continued lung development in pregnancies complicated by oligohydramnios. Lancet. 1987 Dec 5;2(8571):1297–1300. doi: 10.1016/s0140-6736(87)91193-7. [DOI] [PubMed] [Google Scholar]
  12. Murayama K., Jimbo T., Matsumoto Y., Mitsuishi C., Nishida H. Fetal pulmonary hypoplasia with hydrothorax. Am J Obstet Gynecol. 1987 Jul;157(1):119–120. doi: 10.1016/s0002-9378(87)80360-5. [DOI] [PubMed] [Google Scholar]
  13. Patrick J. E., Dalton K. J., Dawes G. S. Breathing patterns before death in fetal lambs. Am J Obstet Gynecol. 1976 May 1;125(1):73–78. doi: 10.1016/0002-9378(76)90895-4. [DOI] [PubMed] [Google Scholar]
  14. Perlman M., Williams J., Hirsch M. Neonatal pulmonary hypoplasia after prolonged leakage of amniotic fluid. Arch Dis Child. 1976 May;51(5):349–353. doi: 10.1136/adc.51.5.349. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Reid L. M. Lung growth in health and disease. Br J Dis Chest. 1984 Apr;78(2):113–134. [PubMed] [Google Scholar]
  16. Roberts A. B., Griffin D., Mooney R., Cooper D. J., Campbell S. Fetal activity in 100 normal third trimester pregnancies. Br J Obstet Gynaecol. 1980 Jun;87(6):480–484. doi: 10.1111/j.1471-0528.1980.tb04582.x. [DOI] [PubMed] [Google Scholar]
  17. Schreiber J., Benedetti T. Conservative management of preterm premature rupture of the fetal membranes in a low socioeconomic population. Am J Obstet Gynecol. 1980 Jan 1;136(1):92–96. doi: 10.1016/0002-9378(80)90572-4. [DOI] [PubMed] [Google Scholar]
  18. Thibeault D. W., Beatty E. C., Jr, Hall R. T., Bowen S. K., O'Neill D. H. Neonatal pulmonary hypoplasia with premature rupture of fetal membranes and oligohydramnios. J Pediatr. 1985 Aug;107(2):273–277. doi: 10.1016/s0022-3476(85)80148-7. [DOI] [PubMed] [Google Scholar]
  19. Trudinger B. J., Lewis P. J., Petit B. Fetal breathing patterns in intrauterine growth retardation. Br J Obstet Gynaecol. 1979 Jun;86(6):432–436. doi: 10.1111/j.1471-0528.1979.tb10785.x. [DOI] [PubMed] [Google Scholar]
  20. Vintzileos A. M., Campbell W. A., Ingardia C. J., Nochimson D. J. The fetal biophysical profile and its predictive value. Obstet Gynecol. 1983 Sep;62(3):271–278. doi: 10.1097/00006250-198309000-00001. [DOI] [PubMed] [Google Scholar]
  21. Wigglesworth J. S., Desai R. Is fetal respiratory function a major determinant of perinatal survival? Lancet. 1982 Jan 30;1(8266):264–267. doi: 10.1016/s0140-6736(82)90986-2. [DOI] [PubMed] [Google Scholar]

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