Results of a management protocol for premature rupture of the membranes.

The results of a management protocol for women with premature rupture of the membranes (PROM) between 27 and 36 weeks' gestation is presented. Prior to 33 weeks' gestation patients were hospitalized and observed for signs of infection; labor was induced if amnionitis was diagnosed. After 33 weeks patients with vertex presentations underwent elective induction of labor after 16 hours of PROM. Amniocentesis was not performed, corticosteroids were not administered, and tocolysis was not used. The overall perinatal mortality rate was 2.8%. There was only 1 death in the group of 44 patients between 33 and 36 weeks' gestation with PROM for more than 16 hours. This neonate had moderate respiratory distress syndrome and a severe intracranial hemorrhage. The cesarean section rate in the group that underwent labor induction after 16 hours of PROM was 22.7% but only 1 of the 10 operations performed might possibly have been avoided if induction had not been a part of the protocol. In the group of 41 patients managed expectantly but delivered after 16 hours of PROM prior to 33 weeks' gestation, 21.9% were clinically believed to have amnionitis but only 12 neonate had documented sepsis. The implications of these results are discussed.

In vitro defects of phagocyte chemotaxis during pregnancy.

Pregnant women have an increased risk for some infections, particularly during the last trimester. Phagocytic emigration from the circulation into tissues is an important aspect of the initial immune response. Therefore, circulating phagocytes of 42 pregnant and 15 postpartum patients were studied in vitro for random and chemotactic (or directional) migration through membrane filters (Millipore Corp., Bedford, Mass.). Random migration of phagocytes from all 42 pregnant patients studied in each trimester was within normal limits. Chemotactic migration of 25 patients who were between 6 and 33 weeks of pregnancy was also similar to values obtained with control leukocytes (20 nonpregnant, normal females. However, phagocytes of 17 other women studied between week 34 of pregnancy and term showed marked depressions in chemotaxis (P less than 0.001 from control values). During labor and within 3 days of delivery, chemotactic migration increased to supranormal levels in 14 of 15 women studied. Sera from six pregnant patients with proven chemotactic defects did not reduce migration when incubated with normal phagocytes. These chemotactic defects appear to be intrinsic and may be important in predisposing to infections during late pregnancy.