الفهرس 
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Abstract
Preterm prelabour rupture of membranes (PPROM) complicates approximately 3% of all pregnancies in the united states and Preterm delivery occurs in approximately 12% of all births in the US, of which nearly one-third follow preterm premature rupture of membranes (PPROM) (Waters and Mercer 2011).
It is associated with increased fetal and maternal morbidity and mortality (Buchanan et al. 2010).
Preterm prelabour rupture of the membranes (PPROM) is an important clinical problem and a dilemma for the gynaecologist. On one hand, awaiting spontaneous labour may lead to an increase in infectious disease for both mother and child, whereas on the other hand induction of labour leads to preterm birth with an increase in neonatal morbidity (e.g., respiratory distress syndrome (RDS) and a possible rise in the number of cesarean deliveries.
The incidence of RDS is estimated to decrease from 15% at 34 weeks to below 1% at 37 weeks’ gestation (Lewis et al. 1996). On the other hand, the probability that sepsis occurs increases when expectant management is advocated. In case the child is born immediately after PPROM, the risk of sepsis is 2.5%, whereas it increases to 7.5% in case of expectant management (Neerhof et al. 1999).
Conservative management of these patients prolonged pregnancy, increased the risk of chorioamnionitis and increased the risk for occult cord compression, without reducing neonatal morbidity (Cox and Leveno 1995).
Patients with PPROM managed expectantly were hospitalised significantly longer. More babies of the expectant group were diagnosed with sepsis and admitted to the neonatal ward for a longer duration (Naef et al. 1998).
At 32 to 33 weeks’ gestation neonatal survival with immediate delivery is likely. There remains a risk however of RDS and other gestational age-dependent morbidities when fetal pulmonary maturity testing be immature. If fetal lung maturity is positive, however the likelihood of pulmonary and other acute major morbidities is low (Mercer 2005).
Many studies suggested that expectant management after 32 weeks leads only to an increased rate of chorioamnionitis and longer maternal and neonatal hospitalization. However, one significant limitation for these studies is the fact that patients managed expectantly received neither corticosteroids nor prophylactic antibiotics (Mercer et al. 1993; Cox and Leveno 1995).
So, expectant management may be appropriate following treatment with corticosteroids and a prophylactic antibiotic regimen. Patients who present at 34 weeks’ gestation or beyond are likely to benefit most from immediate delivery (Dudley et al. 1991).
When expectant management is chosen between 32 and 34 weeks, inpatient hospitalization with daily monitoring is also recommended. The mode of delivery depends on the usual obstetric indications.
This study included 60 cases divided to two groups.
group I (expectant group) 30 cases were managed conservatively.
group II (induction group) 30 cases were induced for labour (by misoprostol or oxytocin) or by C.S.
All included subjects were submitted to full history taking, clinical examination, laboratory investigations and abdominal ultrasound with restricted digital examination.
Both groups were treated with antibiotics and corticosteroids.
The results of the present study revealed:
No significant difference between both groups in neonatal morbidity
In induction group the result was increase in neonatal RDS.
In expectant group the result was increase in neonatal sepsis.
High significant difference between both groups regarding maternal morbidity where in expectant management an increase in chorioamniointis and postpartum endometritis was found.
Significant difference between both groups regarding mode of delivery, where C.S and instrumental delivery were increased in the induction group.