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Midtrimester PPROM Poses Difficult Choices.
SARASOTA, FLA. -- The gray areas of medicine are often the hardest to navigate, and midtrimester preterm premature rupture of membranes is one of them, according to Dr. Washington Hill, director of maternal-fetal medicine at Sarasota Memorial Hospital.
Dr. Hill described the difficult dilemma PPROM presents to patients and caregivers when it occurs between 16 and 26 weeks' gestation in his presentation at a perinatal symposium sponsored by Symposia Medicus.
"You have to sit down with the couple and help them sort through whether or not they want to continue this pregnancy, or whether they are going to choose induction of labor [termination]," he said in an interview.
Although. there is a small chance that the membranes will reseal--anywhere from 2.8% to 13% within an average of 7.5 days--in most cases the natural outcome of PPROM at such early gestational age is delivery. In midtrimester PPROM 60%-70% of patients will deliver in less than a week, and 80% in less than a month.
Physicians need to explain to patients that tocolytics and antibiotics do not always result in a healthy baby "If you manage to extend the pregnancy beyond 24 weeks' gestation, then you have to discuss survival rates and perinatal outcome for delivery at 25 or 26 weeks . . . When ...
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Source: HighBeam Research, Midtrimester PPROM Poses Difficult Choices.