Vaginal Drain to Prevent Ascending Infection in Preterm Premature Rupture of Membranes: A Novel Method.

BACKGROUND: Not to delay delivery for more than 24 hours after rupture of the membrane is the thumb rule in obstetrics. Ascending infection from the vagina results in dangerous chorioamnionitis, which threatens the lives of the baby and mother. We developed a novel method to prevent ascending infection by using a vaginal drain, which helps to continue pregnancies if the leak stops and buys some time for antenatal steroids to act if the leak doesn't stop.

METHOD: In this study, 20 uncomplicated singleton pregnant women with spontaneous preterm premature rupture of membranes at gestational ages <35 weeks were recruited. Under the speculum, vaginal epithelial debris and secretions were cleared by a saline wash. The tip of the Nelaton Catheter was kept in the posterior fornix and then strapped to the thigh. The outer end was connected to the collection bag system and allowed to hang down to the ground. The foot end of the cot was raised. Leaked amniotic fluid and amniotic fluid index (AFI) were measured daily. A daily AFOD estimation was done for leaked AF. Uterine activity was controlled with low-dose Isoxsuprine Hydrochloride rapid infusion tocolysis. Antenatal steroids (ANS) were given. The spread of infection was monitored by maternal pulse rate, fetal heart rate, TC, and CRP. Pregnancies were terminated when leaks didn't stop, AFI didn't raise, or mature AFOD was observed. The number of women in whom leaks stopped, the number of days pregnancies continued, neonatal respiratory distress (NRD), birth weights, and perinatal deaths were recorded.  Results: Leaks stopped in eight (40%) women. Pregnancy continuation ranged from 7 to 74 days. In 12 women, the leak did not stop, but we could buy 2-5 days' time for ANS to act. All parameters of the infection were within normal limits. Thirteen babies developed mild NRD, and we lost one baby.

CONCLUSION: By using a vaginal drain for P(P)ROM, ascending infection can be prevented, leaks can be stopped in 40% of women, and can buy time for ANS to act.