Rotura prematura de membranas antes de la semana 28 de gestación y resultados neonatales

ResumenObjetivoDescribir las características y el pronóstico del manejo conservador en gestantes con rotura prematura de membranas pretérmino (RPMP).Material y métodosEstudio observacional descriptivo de 65 casos de RPMP < 28 semanas, entre 1995 y 2005.ResultadosCaracterísticas principales: gestación múltiple (29,3%), exudado positivo para Estreptococcus agalactiae (Streptococcus del grupo B) (14,85%) y RPMP anterior (16%). La mediana de días de bolsa rota (BR), cuando el índice de Bishop es < 7 es de 14 para gestantes con RPMP < 24 semanas y de 5 para gestantes con RPMP ≥ 24 semanas (p = 0,01).El manejo conservador no aumenta la morbimortalidad, salvo que presenten oligoamnios moderado-severo: el 100% de las corioamnionitis y el 69% de la mortalidad perinatal ocurrieron en gestantes con oligoamnios.ConclusionesLas gestantes con RPMP < 24 semanas e índice de Bishop < 7 presentan mayors períodos de latencia, pero la morbimortalidad maternofetal no aumenta si el índice de líquido amniótico es normal.

ObjectiveTo describe the characteristics and outcomes after conservative management of pregnancies with preterm premature rupture of membranes (PPROM).Material and methodsWe performed a descriptive, observational study of 65 cases of PPROM at less than 28 weeks of pregnancy between 1995 and 2005.ResultsThe main characteristics were twin pregnancies, positive culture for group B Streptococcus agalactiae (14,85%) and previous PPROM (16%). The median number of days with broken membranes, when the Bishop score was < 7, was 14 for pregnancies with PROM < 24 weeks and 5 for pregnancies with PPROM ≥ 24 weeks (P=.01). Conservative management does not increase morbidity or mortality, unless there is moderatesevere oligohydramnios: 100% of chorioamnionitis and 69% of perinatal mortality occurred in pregnancies with oligohydramnios.ConclusionsPregnancies with RPMP < 24 weeks and a Bishop's score of < 7 have a longer latency period and maternal-fetal morbidity and mortality are not increased if the amniotic fluid index is normal.