Very preterm membrane rupture management tactic – clinical aspects

Abstract

The management of premature rupture of membranes is a controversial issue, primarily in terms of the impossibility of diagnosing fetal infection. The article is devoted to the effectiveness of the tactics of choosing the labour time based on the preclinical diagnosis of chorioamnionitis by detecting a low glucose content in the amniotic fluid. For this purpose, we analysed the course of labour in 69 pregnant women with premature rupture of membranes at a gestational age of 25-27 weeks, 34 of whom (group I) received care according to the standard of care, the indications for labour were hypertension, tachycardia and the appearance of laboratory signs of inflammation, and 35 (group II) underwent weekly monitoring of the glucose content in the amniotic fluid. If the value was less than 0.5 μmol/L was an indication for labour, despite the absence of other signs of inflammation. The use of such tactics led to a reduction in the period between rupture of membranes and labour - in 21.6% of group I, it was less than a week, in group II - only 11.7%, a decrease in the gestational age of delivery - in 37.1% of women in the first group it was less than 27 weeks, in group II - 17.6%, an increase in the frequency of abdominal labour - from 17.6% in group I to 31.4% in group II. At the same time, the incidence of hyperthermia was reduced from 20.6% to 8.6% before labour, from 23.5% to 5.7% during labour, and from 29.4% to 2.8% in the postpartum period. Conclusions. 1. The use of the treatment of extremely premature rupture of membranes based on the determination of glucose levels in amniotic fluid, compared with wait-and-see management, leads to a decrease in gestational age at labour and is associated with an increase in the frequency of cesarean section. 2. At the same time, this tactic significantly reduces hyperthermia both before, during and after labour and in the postpartum period.