Rotura prematura de membranas antes de la semana 28 de gestación y resultados neonatales / Preterm premature rupture of membranes and neonatal outcome prior to 28 weeks of gestation

RESUMEN

Objetivo: Describir las características y el pronóstico del manejo conservador en gestantes con rotura prematura de membranas pretérmino (RPMP). Material y métodos: Estudio observacional descriptivo de 65 casos de RPMP < 28 semanas, entre 1995 y 2005. Resultados: Características principales gestación múltiple (29,3%), exudado positivo para Estreptococcus agalactiae (Streptococcus del grupo B) (14,85%) y RPMP anterior (16%). La mediana de días de bolsa rota (BR), cuando el índice de Bishop es < 7 es de 14 para gestantes con RPMP < 24 semanas y de 5 para gestantes con RPMP ≥ 24 semanas (p = 0,01). El manejo conservador no aumenta la morbimortalidad, salvo que presenten oligoamnios moderado-severo el 100% de las corioamnionitis y el 69% de la mortalidad perinatal ocurrieron en gestantes con oligoamnios. Conclusiones: Las gestantes con RPMP < 24 semanas e índice de Bishop < 7 presentan mayores períodos de latencia, pero la morbimortalidad maternofetal no aumenta si el índice de líquido amniótico es normal (AU)

ABSTRACT

Objective: To describe the characteristics and outcomes after conservative management of pregnancies with preterm premature rupture of membranes (PPROM). Material and methods: We performed a descriptive, observational study of 65 cases of PPROM at less than 28 weeks of pregnancy between 1995 and 2005. Results: The main characteristics were twin pregnancies, positive culture for group B Streptococcus agalactiae (14,85%) and previous PPROM (16%). The median number of days with broken membranes, when the Bishop score was < 7, was 14 for pregnancies with PROM < 24 weeks and 5 for pregnancies with PPROM ≥ 24 weeks (P=.01). Conservative management does not increase morbidity or mortality, unless there is moderatesevere oligohydramnios 100% of chorioamnionitis and 69% of perinatal mortality occurred in pregnancies with oligohydramnios. Conclusions: Pregnancies with RPMP < 24 weeks and a Bishop¿s score of < 7 have a longer latency period and maternal-fetal morbidity and mortality are not increased if the amniotic fluid index is normal (AU)