EXPECTANT MANAGEMENT VS ACTIVE MANAGEMENT OF PREMATURE MEMBRANE RUPTURE:
A retrospective cohort study
Abstract
Objective: To evaluate the expectant management (EM) versus active
management (AM) of PROM (Premature Rupture of Membranes) in pregnancies
more than 34 weeks of gestation as a factor associated with a decrease
of neonatal complications because of prematurity. Design: A
retrospective cohort study. Setting: Pregnancy women with 34‒36.6 weeks
of gestation with PROM attended in Carlos Andrade Marín Specialty
Hospital, Quito-Ecuador; in the years 2016 and July 2019. Population:
209 patients: this sample was separately in two groups by inclusion and
exclusion criteria; 103 cases were management expectantly and 106 cases
were management actively. Methods: The risk was estimated calculation
relative risk (RR) and Chi-square with p‒value less than 0.05, 95% CI.
Main Outcome Measures: frequency of neonatal complications in both
groups. Results: The prevalence of PROM was 1.95%, associated with
preterm delivery in 13.59%. Caesarean delivery was 25.2% (EM) and
50.9% (AM) with p <0.05. There were no significant
differences in variables: maternal infection RR: 1,324 (95% CI:
0.972‒1.885) in EM and AM: RR: 0.683 (95% CI: 0.398‒1.172); neonatal
sepsis RR: 0.909 (95% CI: 0.608‒1359) in EM, and RR: 1.091 (95% CI:
0.773‒1540) in AM; respiratory distress syndrome RR: 0.993 (expectant)
and RR: 1.01 (active), and prolonged hospitalization. The risk of
neonatal mortality and necrotizing enterocolitis is higher in newborns
of mothers under AM, with RR: 2,013 (95% CI: 1,723‒2351). Conclusions:
There were no significant differences between both groups, but there was
a significant increase in neonatal mortality, necrotizing enterocolitis,
and caesarean after active management.