Maternal and Neonatal Outcomes of Pregnancies With Periviable and Previable Preterm Premature Rupture of Membranes [ID: 1380561

Abstract

INTRODUCTION: Preterm premature rupture of membranes (PPROM) accounts for one-third of preterm deliveries and is associated with significant perinatal morbidity. Neonatal resuscitation has been extended to earlier gestational ages, including for patients with PPROM, but maternal and neonatal outcomes are not well characterized. Our objective is to compare outcomes after PPROM diagnosis prior to viability (23 weeks 0 days) or in the periviable period (23–25 weeks). METHODS: A retrospective cohort of 101 pregnancies and 112 neonates from July 2015 to May 2018 were identified by maternal ICD-9/10 codes for PPROM. Exclusion criteria include PPROM greater than 24 weeks 6 days and neonatal congenital anomalies. Detailed chart review was performed. Patients were stratified by gestational age (GA) at PPROM and groups were compared according to GA. Chi-square test was used for dichotomous variables and t test for continuous variables. Institutional review board approval was obtained for this study. RESULTS: 27.9% of patients who elected for expectant management delivered after viability (23 weeks 0 days or later). Neonatal death was greater after delivery from pregnancies with previable PPROM in comparison to periviable PPROM with similar gestational age at birth, P=.005. The composite adverse neonatal outcomes occurred in 100% of neonates born after previable PPROM. Maternal outcomes were elevated with both previable and periviable PPROM who elected for expectant management (52.4% versus 35.3%, NS). The maternal morbidity rate after termination of pregnancy was significantly less (26.9%) (P=.047). CONCLUSION: Previable PPROM is associated with higher neonatal death rates, despite similar GA at delivery in comparison to periviable PPROM. Maternal morbidity is high with both previable and periviable PPROM.