Maternal and neonatal outcomes following expectant management of preterm prelabor rupture of membranes before viability

Abstract

Purpose: To provide center-based outcome data on obstetric and neonatal complications arising from expectantly managed pregnancies affected by preterm prelabor rupture of membranes (PPROM) before viability.

Materials and methods: We collected data on 130 consecutive pregnancies complicated by spontaneous rupture of membranes before 24 week’s gestation, occurring over a 7-year period. These were women who delivered >24 h after membrane rupture, and had no signs of chorioamnionitis or advanced labor at admission. Women with amniocentesis-induced PPROM (n = 7) were analyzed separately. The descriptive statistics of obstetrics and neonatal outcomes were reported.

Results: The overall neonatal survival to discharge rate was 33.8%. Stratification of patients into early (12 to 19⁺⁶ weeks’ gestation) and late pre-viable PPROM (20 to 23⁺⁶ weeks’ gestation) revealed a 3.6-fold increase in survival rate in the latter group (12.2% versus 43.8%, p < .001). Pre-viable PPROM following amniocentesis predicted a 100% survival outcome, however anhydramnios impacted negatively. The most common neonatal morbidities of those admitted to intensive care unit were respiratory distress syndrome (78.7%) and bronchopulmonary dysplasia (84.4%). The most common maternal morbidities affecting pre-viable PPROM were clinical chorioamnionitis (47.7%), histological chorioamnionitis (81.8%), retained products of conception (39.3%) and preterm labor (45.4%).

Conclusions: Later gestational ages at PPROM were associated with better survival rates, however neonatal morbidity remained high. Women experiencing pre-viable PPROM following amniocentesis can be reassured, while those with anhydramnios at any time during the latency period should be adequately counseled regarding poorer outcomes.

Keywords:

• Midtrimester PPROM
• preterm prelabor rupture of membranes
• previable
• periviable
• maternal outcomes
• neonatal survival
• preterm birth
• latency

Acknowledgements

We would like to thank Dr Carl Kuschel, Medical Director of neonatal services at the Royal Women’s Hospital, for his input in the interpretation and presentation of neonatal outcome data.

Disclosure statement

No conflict of interest was reported by the authors.