Late preterm rupture of membranes: it pays to wait

摘要

In contrast to previous assumptions, there is increasing evidence that being born in the late preterm period-between 34 and 36 weeks gestation-is associated with important long-term adverse effects. Several adverse outcomes have been reported, including cerebral palsy, more hospital admissions in early childhood, lower childhood height, asthma, limiting long-term illness, and poorer educational attainment. Findings from studies show a gradient of health outcomes with decreasing gestation. An estimated 4-5% of infants are born at 34-36 weeks, and 30% of preterm births follow pre-labour rupture of the membranes. Because of the potential risks of fetal and neonatal infection-although with limited evidence to support this assumption-present guidance favours planned early delivery in women presenting with ruptured membranes at 34-36 weeks. With the emerging evidence of differences in long-term outcomes between late preterm and term infants, robust assessment of the risks and benefits of this strategy is essential, because a small increase in gestation at birth is likely to be beneficial to the infant. In The Lancet, Jonathan Morris and colleagues7 present the results of a pragmatic randomised controlled trial of planned immediate delivery versus expectant management in women presenting with pre-labour ruptured membranes at 34-36 weeks. Findings from this trial advance substantially the evidence on the optimum management strategy in these women.