A predictive neonatal mortality score for women with premature rupture of membranes after 22–27 weeks of gestation

Abstract

Objective: Premature rupture of the membranes (PROM) remains a leading cause of neonatal morbidity. The objectives of the present study were to analyze the outcomes of pregnancies complicated by PROM between 22 and 27⁺⁶ weeks of gestation (WG) and to study antepartum risk factors that might predict neonatal death.

Patients and methods: One hundred and seven pregnancies were analyzed over a 3-year period in a tertiary maternity hospital. The collected maternal and neonatal data were used to model and predict the outcome of PROM.

Results: Prevalence of PROM (for live births) was 1.08%, and the overall survival rate was 59.8%. From preselected candidate variables, gestational age (GA) at PROM (p = .0002), a positive vaginal culture for pathogenic bacteria (p = .01), primiparity (p = .02), and the quantity of amniotic fluid (p = .03) were included in a multivariable logistic regression analysis. The corresponding adjusted odds ratios [95% confidence interval] were, respectively, 0.91 [0.87–0.96], 11.08 [1.65–74.42], 0.55 [0.33–0.91], and 0.97 [0.95–0.99]. These parameters were used to build a predictive score for neonatal death.

Conclusions: The survival rate after PROM at 22–27⁺⁶ weeks of gestation was 59.8%. Our predictive model (built using multivariable logistic regression) may be of value for obstetricians and neonatologists counseling couples after PROM.

Keywords:

• Amniotic fluid index
• outcome
• premature rupture of membranes
• preterm infant
• vaginal culture

Acknowledgements

The authors thank Carl Picard and Jonathan Meynier for statistical analysis and David Fraser for copy-editing assistance.

Disclosure statement

None of the authors has any potential conflicts of interest. The authors alone are responsible for the content and writing of this article.