Preterm premature rupture of the membranes (PPROM) is a significant cause of prematurity, accounting for approximately one third of preterm births in the United States. PPROM occurs in approximately 0.7-2% of all pregnancies nationally, and has a reported recurrence rate of 21%. The elucidation of potential risk factors for PPROM could contribute to a better understanding of its etiology. To study the contributions of 20 potential risk factors, we undertook a case-control study in our clinic population, which has a 5-6% incidence of PPROM. One hundred and thirty-three patients experiencing PPROM were matched for race, age, parity and gestational age with undelivered patients. Studies performed included ultrasonographic examinations, blood levels of ascorbic acid and zinc, microbiologic assays, patient questionnaires, and chart reviews. After stratification of both groups into subgroups based on matching criteria, summary tests of significance and Mantel-Haenszel tests of odds ratios were performed. On univariate analysis the following factors achieved significance at the p less than 0.05 level with 95% confidence intervals: 1) previous history of PPROM 2) smoking (dose related) 3) fundal location of the placenta in the present pregnancy. 4) a prior history of cerclage. After regression analysis, we concluded that smoking and history of previous PPROM were found to be risk factors for PPROM in our inner city black population.

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A retrospective study of a trial of labor (TOL) after prior cesarean section was conducted over 18 months in a patient population that is homogeneous with regard to race, socioeconomic class, gestational age, and medical complications. Of 171 women who had undergone previous cesarean sections, 75 were offered a TOL. Thirty-five of these patients had an elective repeat cesarean section, while 40 agreed to a TOL. Thirty-two of the latter patients delivered vaginally (80%). The criteria for offering a TOL and a protocol for TOL are presented. A comparison of the maternal and neonatal morbidity associated with repeat cesarean section versus TOL do not strongly favor either method of delivery in our population. The patients who had undergone cesarean section for cephalopelvic disproportion (CPD) had the lowest acceptance and the lowest success rate of a TOL. The hospital charges and hospital stay of the two groups are presented. The financial aspects of the two methods of delivery and the impact of Diagnosis Related Groups (DRGs) on the management of these patients are discussed. Careful selection of patients for a TOL is essential to maintain the quality of medical care while responding to pressures to reduce the cesarean section rate and to reduce the costs of medical care.