MANAGEMENT OF PRETERM PREMATURE RUPTURE OF MEMBRANES

The variables enumerated in the preceding paragraphs and the constantly changing and improving technology in neonatal care mean that the data on which to base the best management plans of PPROM are not yet available. Rather, we must be willing to revise our approach to the treatment of this entity constantly as new information is found. However, several important changes in the management of these patients over the last few years were implemented and have had a significant impact on the outcome of these neonates. The use of routine prophylactic intrapartum amnioinfusion is one of these. Although preliminary, the data on prophylactic antibiotic use are promising and have brought us closer to the concept of treating occult intraamniotic infections with antibiotics rather than immediate and indiscriminate delivery. The identification of several factors such as interleukin-1, neutrophil activating peptide-1/interleukin-8, and tumor necrosis factor (TNF) in patients with idiopathic preterm labor may allow us to determine the pathophysiologic mechanism by which preterm labor leading to PPROM is initiated and allow us to tailor treatment specifically. For instance, in such patients, uterine activity may respond to antibiotic therapy rather than the usual tocolytics. Unfortunately, measurements of such factors are not yet widely available and remain primarily research tools. However, these recent findings give us a glimpse of what lies ahead. It is entirely conceivable that a symposium on the management of PPROM eventually will have a section devoted to its prevention that is based on an understanding of its pathophysiology.