Five studies that could change obstetric practices.(Obstetrics)

KAILUA KONA, HAWAII -- Five studies may change the way physicians think about prolonged premature rupture of membranes, perinatal stroke in the fetus, and other topics, Dr. Michael A. Belfort said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.

He delineated five areas in which obstetric practices could change because of these studies, which also included suctioning on the perineum, management of herpes in pregnancy, and vaginal birth after cesarean section.

PPROM

If a pregnant woman with prolonged premature rupture of membranes (PPROM) reaches 34 weeks' gestation, it's probably in the mother's and the baby's best interests to deliver the baby rather than continue expectant management, according to a single-institution observational study (Obstet. Gynecol. 2005;105:12-7).

The investigators studied 430 pregnancies in 1998-2000 with PPROM and 24-36 weeks' gestation to determine optimal delivery time.

Infants were delivered after reaching maturity (34 weeks or later) or after the development of chorioamnionitis, active labor, fetal compromise, or phosphatidyl-glycerol in vaginal pools.

Composite scores for neonatal morbidity suggested that there is limited benefit to continuing expectant management after 34 weeks in women with PPROM. Although this was not a randomized, controlled trial, physicians should seriously consider delivering these babies before 35 weeks' gestation to avoid the risk of abruption, the sudden onset of infection, or other problems, said Dr. Belfort, professor of ob.gyn. at the University of Utah, Salt Lake City.