ABSTRACT
Amniocentesis to guide the management of preterm pregnancies complicated by premature
rupture of the membranes (PROM) has been adopted at several centers. The purpose of
this study was to evaluate this practice prospectively among comparable groups of
patients, which has not previously been reported. Forty-seven patients with PROM at
26 to 34 weeks of gestation and an accessible pocket of amniotic fluid by ultrasound
examination were randomly assigned to an “amniocentesis group” (N = 25) or to a “no
amniocentesis group” (N = 22). Amniocentesis results were utilized when making management
decisions in the amniocentesis group, whereas a clinical basis alone was used in the
no amniocentesis group. Demographic variables were similar between the two study populations
at the time of randomization. There were no antepartum fetal deaths and one neonatal
death in each group. Fetal distress, as judged by the fetal monitor tracing, was more
frequent in the no amniocentesis group (P <.05). The number of days the infant remained
in the hospital was significantly less in the amniocentesis group (median = 8.5 days,
range 2 to 88 days) than in the no amniocentesis group (median = 22 days, range 2
to 110 days, P <.01). This difference in neonatal hospital days appeared to be mainly
due to a slower resolution of the multiple problems of prematurity. No significant
differences in these complications were demonstrated individually. No differences
in antepartum hospital days, postpartum hospital days, post-partum endometritis, or
sepsis were apparent between the two groups. We conclude that amniocentesfs appears
to be an effective diagnostic adjunct in the management of PROM and results in decreased
neonatal hospitalization and fetal distress in labor.
