Clinical and epidemiological studies

..................................................................................................... 4 List of publications .................................................................................... 6 Abbreviations ............................................................................................. 7 Introduction ............................................................................................... 8 Definition of prelabour rupture of the membranes ................................................... 8 Diagnosis of rupture of the membranes .................................................................... 8 Maternal infections ................................................................................................... 9 Neonatal infections ................................................................................................. 11 Pathophysiology ..................................................................................................... 12 Risk factors ............................................................................................................. 13 Natural history ........................................................................................................ 14 Earlier studies of PROM ........................................................................................ 15 Randomised studies of PROM with oxytocin ........................................................ 15 Randomised studies of PROM with prostaglandin versus oxytocin ....................... 17 Randomised studies of PROM with prostaglandin versus expectancy .................. 18 Bathing in labour after PROM ............................................................................... 18 Evidence-based medicine ....................................................................................... 18 Statistical power analysis ....................................................................................... 18 Example of a power analysis .................................................................................. 20 Aims of the study ..................................................................................... 21 Material and methods ............................................................................. 22 Clinical studies ....................................................................................................... 22 Epidemiological study ............................................................................................ 26 Statistical methods .................................................................................................. 27 Results and discussion ............................................................................. 28 Prevalence of PROM (Study V) ............................................................................. 28 Risk factors of PROM (Study V) ........................................................................... 28 Diagnosis of ROM and management of equivocal PROM (Study IV) .................. 29 Management of PROM (Study I) ........................................................................... 30 Obstetrical outcome in nulliparous women (Study I) ............................................. 31 Obstetrical outcome in parous women (Study I) .................................................... 35 Maternal infections (Study I) .................................................................................. 35 Neonatal outcome (Study II) .................................................................................. 36 Predictors of neonatal sepsis (Study II) ................................................................. 38 GBS and PROM (Study II) ................................................................................... 38 Neonatal CRP, Apgar Score and acid-base status (Study II) ................................. 39 Warm tub bathing in women with PROM (Study III) ............................................ 40 Conclusions .............................................................................................. 41 Management of PROM at or near term Clinical recommendations 42 Need for further research about PROM................................................ 43 Acknowledgements .................................................................................. 44 Sammanfattning på Svenska (Summary in Swedish) .......................... 45 References ................................................................................................. 46