Trattamento Ostetrico Pro-Attivo nella Prematurita’ Spontanea al Limite della Vitalita’

Objective. To evaluate which factors influence the possibility of applying obstetric "pro-active" management and its effect on neonatal survival near the limit of viability. Study Design. A retrospective cohort study was carry out in our Institution including all consecutive neonates born at 23.0-25.6 weeks of gestation after preterm labour or preterm premature rupture of membranes (pPROM) from March 2003 to May 2008. In particular, factors influencing use of "pro-active" management and its effect on neonatal survival were evaluated. "Pro-active management" includes prolongation of pregnancy with use of tocolytic, antibiotic and steroid therapy. Statistical analysis was performed with Chi-Square test, Fisher Exact test and One-Way ANOVA with p<0.05 significant and 95% CI excluding unit. Results. A total of 40 neonates were included. Newborn's survival was 58% (23/40) and it was significantly influenced by gestational age at delivery (24.9±0.5 vs 24.4±0.9, p=0.02). A significant association between the administration of a full course of antenatal steroids and survival was observed (74% vs 29%, p=0.01, OR=6.8), whereas an incomplete one did not appear useful. "Pro-active" management was significantly associated with higher gestational age at delivery and neonatal survival (69% vs 36%, p=0.04), instead no significant association was observed with nulliparity, pPROM, clinical choriamnionitis, and cervical length and dilatation on admission. Discussion. A "pro-active" management including a complete course of steroids increases neonatal survival and does not seem to be influenced by obstetric variables and cervical characteristics on admission. © Copyright 2009, CIC Edizioni Internazionali, Roma.