Objective This study was undertaken to evaluate whether aggressive to colysis i mproves pregnancy outcome after preterm premature rupture of the membranes (PPRO M). Study design Retrospective case-control study of patients with PPROM before 34 weeks of gestation, followed by a prospective cohort study with historical c ontrols. The retrospective phase covered 1995 through 1999 when we used tocolysi s aggressively. With the use of survival analysis, we compared latency in our ca ses with 4 published control series in which tocolysis was never used. On the ba sis of the results, we adopted a new protocol in mid-2000 limiting tocolysis to 48 hours after betamethasone dosing and we conducted a 2-year prospective eval uation of this new protocol. Results In the retrospective phase, tocolysis was u sed in 94%of 130 cases and maintained during 84%of 1162 total antenatal patien t-days. There was no difference in latency between our cases and the published controls. One or more complications of tocolysis occurred in 18%. In the prospe ctive study, 43%of 63 patients received tocolytics, but these were used at lowe r doses and were given during only 7%of 770 patient-days. Latency with this ve ry limited tocolytic regimen (median 4.5 days, interquartile range 2.3 to 14.0) was not significantly different than during the last 24 months of aggressive toc olysis (median 3.8 days, 1.8 to 14 days, P=.16) and there were no differences in neonatal morbidity. Conclusion Aggressive tocolysis after PPROM causes significant maternal morbidity, but does not incr ease latency or decrease neonatal morbidity compared with either very limited to colysis or no tocolysis at all.
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