Riesgo y beneficio del manejo conservador o interrupción temprana de embarazo pretérmino con ruptura prematura de membrana

Abstract:

Background: The management of preterm premature rupture of membranes (PPROM) still is controversial, especially regarding conservative management and immediate rupture, so more studies are needed. Objectives: To determine if there are differences in neonatal and maternal risks and benefits between conservative management and early rupture in preterm pregnancies complicated with PPROM. Methodology: A non-randomized control study was conducted including 20 pregnant women with indication for early rupture and 29 patients managed conservatively for a diagnosis of preterm PPROM at the Teodoro Maldonado Carbo Hospital, Guayaquil, between January 1, 2017, and June 31, 2021. Results: In the mother, conservative management was associated with fewer cesarean sections (p 0.002 / OR= 0.115; IC 95% 0.026 - 0.507), shorter prenatal (p 0.000) and postnatal stay (p 0.040) than with early rupture; there were no differences in relation to use of additional antibiotics or development of chorioamnionitis. Among neonates, conservative treatment was associated with lower birth weight (p 0.076), Apgar at 1 minute (p 0.018; OR= 5.777: IC95% 1.298 – 25.709) and 5 minutes (p 0.003; OR= undefined), need for surfactant (p 0.000; OR= 15.333: IC95% 3.717 – 63.243), mechanical ventilation (p 0.001; OR= 7.200: IC95% 1.933 – 26.813), neonatal infection (p 0.000; OR= 11.500: IC95% 2.971 – 44.519), early neonatal infection (p 0.000; OR= 16.095: IC95% 3.564 – 72.677), NICU admission (p 0.003; OR= 7.875: IC95% 2.279 – 27.208), hospital stay (p 0.000) and total length of stay (p 0.000). There were no differences in birth weight, Apgar at 10 minutes, time on oxygen therapy, necrotizing enterocolitis, NICU stay and neonatal death. Conclusions: Management with early rupture implies fewer risks and better maternal and neonatal outcomes.

Año de publicación:

2022

Keywords:

• FACTORES DE RIESGO
• Hospital de Especialidades Teodoro Maldonado Carbo
• ECUADOR
• CANTÓN GUAYAQUIL
• Antibiotics
• EMBARAZO PRETÉRMINO
• recién nacido

Fuente:

rraae