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RESULTADO NEONATAL ADVERSO EN LA ROTURA PREMATURA DE MEMBRANAS DE PRET脡RMINO SEG脷N EL MODO DEL PARTO
Objetivo: Evaluar el resultado neonatal adverso seg煤n modo de parto en la rotura prematura de membranas de pret茅rmino (RPMPT). M茅todos: Participaron 135 embarazadas entre 24 y 34 semanas de gestaci贸n con diagn贸stico 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 evaluaci贸n microbiol贸gica del l铆quido amni贸tico y c茅rvicovaginal, y recibieron antibi贸ticos, corticoesteroides y manejo expectante hasta las 35 semanas. Se defini贸 resultado neonatal adverso (RA) compuesto, la variable que incluy贸 morbilidad neonatal severa, secuelas o muerte neonatal. Se defini贸 invasi贸n microbiana de la cavidad amni贸tica (IMCA) por cultivo positivo del l铆quido amni贸tico. Funisitis se diagnostic贸 por la presencia de leucocitos polimorfonucleares en la pared de los vasos umbilicales o gelatina de Warthon. La ces谩rea se realiz贸 por indicaciones obst茅tricas o por urgencias. Para el an谩lisis se us贸 curva ROC y chi cuadrado. Resultados: Se incluyeron 116 pacientes. Modo del parto: vaginal 50,1% y ces谩rea 49,9%. La IMCA fue 52,6% y el RA 17,2%. El RA no dependi贸 del modo del parto (vaginal 13,6% vs. ces谩rea 21,1%). La v铆a del parto no influy贸 en el RA de los subgrupos donde este resultado fue m谩s 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 deliver