Transabdominal Amnioinfusion in Preterm Premature Rupture of Membranes

Preventing premature rupture of membranes (pPROM) is a major concern of obstetricians. It occurs in 45% of all preterm deliveries and accounts for 20% of all cases of perinatal mortality. Evidence exists that prolonging time in utero after pPROM can enhance survival. Some studies have reported a significant increase in the pPROM-delivery interval after amnioinfusion. These same reports have also suggested that an adequate amniotic fluid volume is needed in the latency period to prolong pregnancy. In 1 negative study, there was no increase in birth weight or gestational age at delivery following transabdominal amnioinfusion because the pPROM-delivery interval was not significantly prolonged. However, most studies have observed increased birth weight and gestational age at delivery, and decreased perinatal morbidity and mortality as a consequence of a prolonged pPROM-delivery interval and prolonged pregnancy after amnioinfusion. This prospective randomized controlled study assessed the effect of transabdominal amnioinfusion on maternal and neonatal outcomes among women with pPROM during singleton live pregnancy—between 26 and 33 + 6 weeks who had an amniotic fluid index (AFI) less than the fifth percentile. The study was conducted in India between 2005 and 2007. All women in the study group were treated with transabdominal amnioinfusion at admission. After this initial treatment, the AFI was measured at weekly intervals, and the procedure was repeated when the AFI fell below the fifth percentile. The participants included 60 women who were randomized to the study group (n = 30) or the control group (n = 30). Women in the control group received expectant management. There was no statistically significant difference between the groups in the mean interval from pPROM to delivery (study group: 7.27 ± 7.53 days vs. control group: 6.70 ± 5.93 days, P = 0.75). Several adverse neonatal outcomes, however, were significantly reduced in comparison with the control group (fetal distress: 10% vs. 37%; early neonatal sepsis: 17% vs. 63%; and neonatal mortality: 17% vs. 63%), and maternal outcomes were also improved (including a higher rate of spontaneous delivery: 83% vs. 53%; and reduced postpartum sepsis: 7% vs. 33%). These findings show that transabdominal amnioinfusion does not increase the pPROM to delivery interval. However, it may increase the proportion of women with pPROM who deliver spontaneously. The investigators believe that the procedure appears to be a safe and simple intervention—with no apparent maternal or fetal risks—that potentially improves maternal and neonatal outcomes.