Revista Chilena de Obstetricia y Ginecología (Jan 2007)
RESULTADO NEONATAL ADVERSO EN LA ROTURA PREMATURA DE MEMBRANAS DE PRETÉRMINO SEGÚN EL MODO DEL PARTO
Abstract
Objetivo: Evaluar el resultado neonatal adverso según modo de parto en la rotura prematura de membranas de pretérmino (RPMPT). Métodos: Participaron 135 embarazadas entre 24 y 34 semanas de gestación con diagnóstico de rotura prematura de membranas. Se excluyeron pacientes en trabajo de parto y condiciones maternas y fetales severas que pudiesen alterar el resultado perinatal. Todas las embarazadas tuvieron evaluación microbiológica del líquido amniótico y cérvicovaginal, y recibieron antibióticos, corticoesteroides y manejo expectante hasta las 35 semanas. Se definió resultado neonatal adverso (RA) compuesto, la variable que incluyó morbilidad neonatal severa, secuelas o muerte neonatal. Se definió invasión microbiana de la cavidad amniótica (IMCA) por cultivo positivo del líquido amniótico. Funisitis se diagnosticó por la presencia de leucocitos polimorfonucleares en la pared de los vasos umbilicales o gelatina de Warthon. La cesárea se realizó por indicaciones obstétricas o por urgencias. Para el análisis se usó curva ROC y chi cuadrado. Resultados: Se incluyeron 116 pacientes. Modo del parto: vaginal 50,1% y cesárea 49,9%. La IMCA fue 52,6% y el RA 17,2%. El RA no dependió del modo del parto (vaginal 13,6% vs. cesárea 21,1%). La vía del parto no influyó en el RA de los subgrupos donde este resultado fue más frecuente: Objective: To determine adverse neonatal outcome in patients with preterm PROM according to mode of delivery. Methods: 135 patients with preterm PROM between 24 and 34 weeks participated in this study. Exclusion criteria were labor, and additional fetal and maternal conditions that may influence perinatal outcome. Microbiologic assessment of amniotic cavity and the lower genital tract was performed. MIAC was defined as the presence of a positive amniotic fluid culture. Patients received antibiotics, steroids and were managed expectantly until 35 weeks. Cesarean section was performed if medically indicated or in urgency conditions. A composite variable including severe neonatal morbidity, sequelae or death was used. Funisitis was diagnosed in the presence of polymorphonuclear leukocyte infiltration into the umbilical vessel walls or Wharton jelly. Statistics were performed using ROC curve and chi square analysis. Results: 116 patients were included. Vaginal delivery occurred in 50.1% and cesarean delivery was performed in 49.9%. Frequency of MIAC was 52.6%. Adverse neonatal outcome (AO) was present in 17.2%.AO is not associated with mode of delivery (vaginal 13.6% or cesarean section 21.1%). Within the subgroups with birth weight less than 1500 g or 31 or less week gestation, AO was more frequent than good outcome, but there were no differences in the neonatal outcome between these subgroups with mode of delivery. AO was correlated with infectious variables: MIAC 25%, S agalactiae intraamniotic infection 71.4%, histological chorio-amnionitis 100% and funisitis 94%. The cut off point of the ROC curve for gestational age and risk neonatal outcome was 30 weeks at labor. Conclusions: In patients with preterm PROM and expectant management with antibiotics and corticosteroids, adverse neonatal outcome no depends on mode of delivery
