OUTCOMES OF PREGNANCY IN PREMATURE RUPTURE OF AMNIOTIC MEMBRANES DEPENDING ON DURATION OF ITS PROLONGATION

Aim. Evaluation of pregnancy outcomes depending on the duration of its prolongation in preterm rupture of amniotic membranes at 22 to 34 weeks gestation period. Material and Methods. Outcomes of pregnancy were studied in 196 patients of the contingent of O. Gudushauri National Medical Center with prenatal rupture of amniotic membranes at gestational age of 22 to 34 weeks, who underwent treatment aimed at prolongation of pregnancy in 2016-2018. All the patients were divided into 2 groups. Group 1 included pregnant women in whom it was possible to prolong the pregnancy for 14 days or more; group 2 included women in whom pregnancy could not be prolonged or duration of prolongation was less than 14 days. The patients who were clinically stable, after examination and observation for 48 hours, were discharged from hospital and, subsequently, were observed and treated on an outpatient basis. In order to identify contraindications for prolongation of pregnancy on the part of the mother, a routine clinical and laboratory examination was carried out: complete blood count, biochemical blood test, coagulogram, general urine analysis, bacterioscopy of a vaginal smear, bacteriological examination of the vaginal secretion. Diagnostics of the fetal condition included ultrasound fetometry with daily assessment of the amniotic fluid index using Voluson e8 Expert ultrasound device, daily cardiotocography (CTG) using Sonicaid Team Cape device, as well as Doppler study of blood flow in the umbilical cord artery, fetal aorta, and uterine arteries. Results. In premature rupture of amniotic membranes, a significantly higher incidence of premature birth was revealed in pregnant women of group 2 with prolongation of pregnancy for less than 14 days: 76 (100%), compared with group 1 with prolongation for 14 days or more: 40 (33.33%) (p<0.0001). The average gestational age at which childbirth took place was significantly greater in group 1 than in group 2: 35.92±3.65 weeks and 29.97±3.02 weeks, respectively (t=-12.38, p<0.0001). The same can be said about the average weight of the fetus at birth: 2660.33±876.55 g in group 1 and 1488.68±61.94 g in group 2 (t=-10.17, p<0.0001). In the group without prolongation, compared with patients in group 1, there was an increase in the comparative risk of such complications of the newborn as patent ductus arteriosus, RR=2.50 (95% CI: 1.84 to 3.39); chronic hypoxia, RR=5.00 (95% CI: 3.23to 7.72); retinopathy, RR=2.939 (95% CI: 2.108 to 4.097); hemolytic disease, RR=5.16 (95% CI: 2.80 to 9.50); infections, RR=6.54 (95% CI: 4.04 to 10.61); respiratory distress syndrome, RR = 2.88 (95% CI: 2.29 to 3.61); intraventricular hemorrhage, RR=7.14 (95% CI: 2.40 to 21.21). Due to the presence of complications, newborns from women of group 2 required antibiotic therapy, RR=3.14 (95% CI: 2.46 to 4.00); installation of surfactant, RR=4.76 (95% CI: 1.49 to 15.19). Conclusion. Prolongation of pregnancy for more than 14 days in case of preterm rupture of amniotic membranes in the period of 22-34 weeks, reduces the risk of unfavorable perinatal outcomes.