249: Outcomes of pregnancies complicated by preterm premature rupture of membranes before 24 Weeks of gestation

Abstract

Counselling to women with previable preterm premature rupture of membranes (PPROM) represents a great challenge, as data regarding outcomes in these cases in the current era of neonatal care are limited. Our aim was to assess the natural history and contemporary outcomes in cases of previable preterm premature rupture of membranes. This was a retrospective study of all women who were admitted to a single tertiary referral center with PPROM between 20+0 and 23+6 weeks of gestation and underwent expectant management from 2004 to 2014. Patients electing immediate delivery or carrying anomalous fetuses were excluded. 1) Out of 140 women with previable PPROM, 104 women met the study criteria with a mean gestational age at PPROM of 22.6±1.1 weeks. 2) The mean latency period was 15.8±18.5 days, and was inversely related to gestational age at PPROM. 3) Mean gestational age at delivery was 25.0±2.4 weeks; the proportion of women delivering at ≥24, ≥25 and ≥26 weeks was 59.3%, 31.5% and 26.9%, respectively. 4) The most common complication associated with expectant management was clinical chorioamnionitis (41.7%), followed by stillbirth (11.5%), cord prolapse (7.4%) and placental abruption (4.6%). 5) Of the 66 (63.5%) live born neonates actively treated, 52 (78.8%) survived to discharge, 42 (81%) of whom experienced major neonatal morbidity (Figure and Table). 6) The overall survival rate was 50% (52/104), and was significantly lower in cases of PPROM before 22 weeks of gestations (22.2% vs. 59.7%, p=0.001). 7) The most important predictors of survival were gestational age at PPROM > 22+0 weeks (OR 6.6, 95%-CI 1.6-26.7) and gestational week at delivery (OR 1.8, 95%-CI 1.3-2.4). Expectant management in cases of previable PPROM is associated with significant maternal risks and with an overall neonatal survival rate of 50%. The survival rate is much lower in cases of PPROM before 22 weeks, and the majority of survivors experience major morbidity. This information is valuable for counseling to women with previable PPROM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)