Intrapartum and delivery room management of premature rupture of membranes complicated by oligohydramnios

Abstract

Intrapartum management of PROM is affected as much by quantity of amniotic fluid remaining in the uterine cavity as gestational age at which PROM occurs. Strategies for PROM must take into account the unique mechanical and developmental fetal risks, as well as greater infectious morbidities associated with severe oligohydramnios. Perinatal management should include close fetal monitoring, timely intervention, and the provision of skilled neonatal resuscitation once the infant is delivered. Etiology of cardiopulmonary distress in the neonate may initially be difficult to determine. Surfactant deficiency (RDS), congenital pneumonia, cardiopulmonary asphyxia, and pulmonary hypoplasia should be included in the differential diagnosis. The duration and severity of oligohydramnios, plus clinical, radiographic, and laboratory data, should provide clues for accurate diagnosis and appropriate treatment.