Determinants of favourable neonatal outcome after premature rupture of membranes (PROM) before 24 weeks of pregnancy--review of the literature and a case report.

OBJECTIVES Premature rupture of the membranes (PROM) in pregnancy refers to rupture of membranes of the amniotic sac and chorion. The aim of the study was to review the literature and analyze the course of pregnancy (primipara) complicated by the premature rupture of the membranes, and consequent loss of amniotic fluid after 19 weeks of gestation. STUDY DESIGN A 27-year old primiparous patient was admitted to the Gynaecology and Obstetrics University Hospital in Poznań on 9 December 2010, due to suspected premature rupture of the membranes. On presentation, foetal development was at 19 weeks gestation. Standard clinical investigations included ultrasonography, amniotic fluid index measurements and laboratory blood tests. RESULTS Ultrasonography confirmed the size of the foetus to be normal for the gestational age. However, no amniotic fluid pockets were visible and the amniotic fluid index was 0 cm. The patient was hospitalized on multiple occasions and as a result a decision was made to end the pregnancy prematurely by means of a caesarean section at 32 weeks of gestation. Longer-term observation of the newborn indicated that one year following delivery, the development of the baby was normal, and thus far no neurological injuries or complications have been observed. CONCLUSION The pregnancy was ultimately successfully completed with the delivery of a healthy newborn at 32 weeks of gestation. A regime involving rigorous bed rest and antibiotic administration can positively extend the duration of pregnancies complicated by premature rupture of the membranes.