Is conservative management of preterm rupture of membranes justified?

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Abstract
Management of preterm rupture of membranes (ROM) is controversial. Some advise immediate delivery and others advocate a conservative approach in the hope of decreasing morbidity and mortality rates associated with prematurity. A retrospective review of 75 pregnancies with preterm ROM treated conservatively was performed to delineate the relative risk factors. All patients with preterm ROM were placed on bed rest until labor or chorioamnionitis prompted delivery. Chorioamnionitis developed in 25% of the cases. Percentage of women developing chorioamnionitis increased with duration of ROM. Fetal morbidity and mortality were not increased in the group with chorioamnionitis. Hyaline membrane disease (HMD) and intraventricular hemorrhage (IVH) were the major causes of neonatal death in the entire group of preterm ROM. There was a significant relationship between neonatal mortality and birth weight. The smaller the birth weight, the greater the risk of neonatal death. Data support the conservative approach to preterm ROM, especially in the very-low-birth-weight group where extreme caution must be taken before a decision is made to terminate pregnancy.