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EXPECTANT MANAGEMENT VS ACTIVE MANAGEMENT OF PREMATURE MEMBRANE RUPTURE: A retrospective cohort study
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  • Amanda Jácome Espinoza,
  • Luis Hidalgo Yánez,
  • María Carrasco Guerra,
  • Lautaro Chávez Iza
Amanda Jácome Espinoza
Hospital Carlos Andrade Marin
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Luis Hidalgo Yánez
Hospital Carlos Andrade Marin
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María Carrasco Guerra
Pontificia Universidad Catolica del Ecuador
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Lautaro Chávez Iza
Hospital Carlos Andrade Marin
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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.