Preterm prelabour amniorrhexis

Abstract

Preterm delivery occurs in less than 10% of pregnancies but accounts for more than 60% of all neonatal deaths. Approximately one third of preterm deliveries are associated with preterm prelabour amniorrhexis and in a high proportion of such cases the underlying cause may be ascending infection from the lower genital tract. The causes of neonatal death in pregnancies with amniorrhexis are prematurity, pulmonary hypoplasia and sepsis. In the management of pregnancies with preterm prelabour amniorrhexis it is essential to distinguish between those with and without intrauterine infection. If there is no infection at presentation it is unlikely that this will develop and in such cases there is no benefit from hospitalisation, bed rest, prophylactic tocolytics or antibiotics. The group with evidence of intrauterine infection go into spontaneous labour within a few days of amniorrhexis; in this group the main determinant for the appropriate management is the gestation at amniorrhexis.