Outcomes with premature rupture of membranes at 32 or 33 weeks when management is based on evaluation of fetal lung maturity

Objective: To assess outcomes of patients with premature rupture of membranes (PROM) at 32 or 33 weeks gestation. Methods: This historical cohort study included all immune competent patients managed at our institution from October 1, 1999 to March 31, 2003 with singleton gestations and PROM at 32 or 33 weeks, and without clinical chorioamnionitis at presentation or antenatal diagnosis of a fetal anomaly. If amniotic fluid studies revealed pulmonary maturity, patients were intentionally delivered. Otherwise, they were expectantly managed until intentional delivery at 34 weeks, or labor, chorioamnionitis, or nonreassuring testing led to delivery sooner. Results: For the groups with mature (n = 29) and immature or unobtainable (n = 60) fluid, respectively, rates of neonatal ICU admission (83% vs. 77%; p = 0.51), respiratory distress (41% vs. 45%; p = 0.75), mechanical ventilation (10% vs. 17%; p = 0.53), and proven neonatal infection (4% vs. 2%; p = 0.60) were similar, as were rates of other neonatal and mat...