Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- 1 The epidemiology of preterm labour and delivery
- 2 Biology of preterm labour
- 3 Transcriptional regulation of labour-associated genes
- 4 Fetal outcome following preterm delivery
- 5 The prediction of preterm labour
- 6 Prevention of preterm labour
- 7 Management of preterm premature ruptured membranes
- 8 Management of threatened preterm labour
- 9 Management of preterm labour with specific complications
- 10 Anaesthetic issues in preterm labour, and intensive care management of the sick parturient
- 11 Management of the preterm neonate
- 12 Organisation of high risk obstetric and neonatal services
- 13 The management of pregnancy and labour
- 14 Treating the preterm infant – the legal context
- Index
- References
7 - Management of preterm premature ruptured membranes
Published online by Cambridge University Press: 07 August 2009
- Frontmatter
- Contents
- Contributors
- Preface
- 1 The epidemiology of preterm labour and delivery
- 2 Biology of preterm labour
- 3 Transcriptional regulation of labour-associated genes
- 4 Fetal outcome following preterm delivery
- 5 The prediction of preterm labour
- 6 Prevention of preterm labour
- 7 Management of preterm premature ruptured membranes
- 8 Management of threatened preterm labour
- 9 Management of preterm labour with specific complications
- 10 Anaesthetic issues in preterm labour, and intensive care management of the sick parturient
- 11 Management of the preterm neonate
- 12 Organisation of high risk obstetric and neonatal services
- 13 The management of pregnancy and labour
- 14 Treating the preterm infant – the legal context
- Index
- References
Summary
Introduction
It would be reasonable to question the need for a separate chapter dealing with the management of preterm, premature rupture of the fetal membranes (pPROM). After all, pPROM is present in up to 40% of cases of premature labour, almost always results in birth of a premature infant and has a common infectious aetiology with preterm labour. However, important data, such as those from the ORACLE 1 randomised trial which showed therapeutic benefit from maternal antibiotic treatment after pPROM but not preterm labour with intact membranes, suggest that in some respects these two clinical scenarios should be considered as separate, but related entities.
The increasing realisation that the fetal inflammatory response to materno-fetal infection can lead to bronchopulmonary dysplasia and long-term neurological disability is now a key factor in the management of pPROM. The high frequency of proven intra-amniotic infection (approximately 30%) with pPROM, potentially long delays between presentation and spontaneous onset of labour, and evidence that the rate of microbial invasion increases over time (up to 75% by the onset of labour), give rise to management issues unique to this pregnancy complication. These issues include: how is materno-fetal infection and its inflammatory consequences best detected, are there therapeutic interventions which can ameliorate the fetal inflammatory response and so reduce perinatal and long-term morbidity, and when is the optimal time to deliver the fetus? As will become clear, the data are not yet available to answer many of these questions.
- Type
- Chapter
- Information
- Preterm LabourManaging Risk in Clinical Practice, pp. 171 - 190Publisher: Cambridge University PressPrint publication year: 2005