Maternal and Perinatal Outcomes Following Expectant Management of Preterm Premature Rupture of Membranes Before 25 Weeks of Gestation: A Retrospective Observational Study

Abstract

Background: The aim of the study was to determine maternal and perinatal outcomes of expectantly managed pregnancies complicated by preterm premature rupture of membranes (PPROM) prior to 25 weeks gestation. Methods: A retrospective observational study was conducted of women with singleton pregnancies, complicated by PPROM occurring between 14+0 and 24+6 weeks at Ibri Regional Hospital, for a period of 5 years (January 2011 to December 2015). Risk factors and maternal and neonatal outcomes following expectant management were assessed and comparisons were made between early (14 - 19+6) and late (20 - 24+6) previable PPROM. Results: The prevalence of PPROM was 0.24% (46 cases/birth). There were 20 cases (48%) in the early PPROM group and 21 cases (51%) in the late group. A total of 21 babies (51.2%) were born alive, 15 from the late group and six from the early group. Sixteen women (39%) had miscarriage. One baby (2.43%) died in utero , two babies (4.7%) died intrapartum, and 10 babies (24.4%) died in the neonatal period. Nine babies (21.9%) survived to discharge without major morbidities. There were no cases of maternal sepsis or mortality. Conclusion: Previable PPROM represents a rare but significant challenge to obstetricians in terms of management. Most cases are managed expectantly. Despite advances in obstetric and neonatal care, perinatal prognosis remains poor. However, the risk of severe maternal morbidity and mortality is low. A quarter of these women can take home a live baby. J Clin Gynecol Obstet. 2018;7(1):13-19 doi: https://doi.org/10.14740/jcgo466w