An aggressive interventional protocol for early midtrimester premature rupture of the membranes using gelatin sponge for cervical plugging.

OBJECTIVE

This study was performed to evaluate a protocol for treatment of previable premature rupture of membranes (PROM) that includes the administration of gelatin sponge to retard the loss of fluid from the amniotic cavity.

METHODS

Women with PROM at

RESULTS

Fifteen women with PROM at 17.9 +/- 2.2 weeks' gestation (range 13-21 weeks) underwent this protocol. Spontaneous PROM was diagnosed in 14 patients and one had iatrogenic PROM after fetoscopy. Eight fetuses reached a viable gestational age (>or=24 weeks, 53%), with six of these newborn infants surviving to hospital discharge (30%) and two suffering intrauterine death. The average gestational age of delivery for survivors was 31.8 +/- 4.3 weeks, range 25 to 36 weeks. Talipes equivarus was observed in three survivors (50%). Bilateral hip dysplasia and torticollis were also diagnosed in two infants. Respiratory distress syndrome was diagnosed in all cases delivered at less than 32 weeks but was not observed thereafter. No adverse sequelae have been attributed to gelatin sponge exposure.

CONCLUSIONS

The observed survival rate with this interventional approach in a population at highest risk for pregnancy loss justifies further study of this treatment strategy. This protocol may not reduce the rate of musculoskeletal abnormalities.