Serial thoracic versus abdominal circumference ratios for the prediction of pulmonary hypoplasia in premature rupture of the membranes remote from term

OBJECTIVES: The purpose of this study was to evaluate the fetal thoracic versus abdominal circumference ratio in the prediction of pulmonary hypoplasia after preterm premature rupture of the membranes. STUDY DESIGN: A standard curve of thoracic versus abdominal circumference ratio versus gestational age was derived from 120 uncomplicated pregnancies. Thoracic versus abdominal circumference ratio and amniotic fluid estimations were obtained serially in 16 women with premature rupture of the membranes at <26 weeks' gestation. RESULTS: An abnormal thoracic versus abdominal circumference ratio predicted lethal pulmonary hypoplasia in six infants. A progressive decline in thoracic versus abdominal circumference ratio was identified in all of these patients. Six of eight women with persistent oligohydramnios had abnormal thoracic versus abdominal circumference ratios and lethal pulmonary hypoplasia. Two surviving infants had restriction deformities and pulmonary complications. CONCLUSIONS: In the setting of premature rupture of the fetal membranes at <26 weeks, serial thoracic versus abdominal circumference ratio measurement is a reliable predictor of pulmonary hypoplasia. Persistent oligohydramnios is ominous because of the risk of restriction deformities and pulmonary complications in the survivors.