Abstract
Background and Objectives: Pre-term premature rupture of membranes (PPROM) responds for one third of preterm births, and it is associated with other complications that increase the risk of maternal or fetal poor outcome. To reduce uncertainty and provide accurate information to patients, the analysis of the large series is of great importance. In order to learn about the evolution over the time of the obstetric and perinatal outcomes in cases of PPROM at, or before, 28 weeks (very early PPROM) managed with an expectant/conservative protocol, we have designed the present study. Materials and Methods: We retrospectively studied all cases of very early PPROM attended in Malaga University Regional Hospital from 2000 to 2020. Results: Among 119,888 deliveries assisted, 592 cases of PPROM occurred in pregnancies at or before 28 weeks (0.49% of all deliveries, 3.9% of all preterm births and 12.9% of all cases of PPROM). The mean duration of the latency period between PPROM and delivery was 13.5 days (range 0 to 88 days), enlarging over the years. The mean gestational age at delivery was 27 weeks (SD 2.9; range 17–34). The proportion of cesarean deliveries was 52.5%. The overall perinatal mortality rate was 26.5%, decreasing over the period with a significant correlation Pearson’s coefficient −0.128 (p < 0.05). Conclusions: In the period 2000–2020, there was an improvement in the outcomes of very early PPROM cases and perinatal mortality showed a clear trend to decrease.
Highlights
Pre-term premature rupture of fetal membranes (PPROM) complicates 2–3% of all pregnancies [1]; responds for one third of all cases of preterm birth [2]; and it is associated with secondary complications, which increase the risk of maternal or fetal poor outcome, like placental abruption, cord prolapse and intraamniotic infections [3]
A careful balance between maternal and neonatal risks is needed since a prolonged latency period between PPROM and delivery improves neonatal outcomes, but it could increase the risk of chorioamnionitis [11,12]
The perinatal mortality figures associated with very early PPROM are high [13,14], but in recent years, some studies have demonstrated that outcomes for neonates delivered following very early PPROM may be better than previously expected [10]
Summary
Pre-term premature rupture of fetal membranes (PPROM) complicates 2–3% of all pregnancies [1]; responds for one third of all cases of preterm birth [2]; and it is associated with secondary complications, which increase the risk of maternal or fetal poor outcome, like placental abruption, cord prolapse and intraamniotic infections [3]. The prolongation of pregnancy needs to be considered the primary goal of expectant management when infection is not present [8], especially in very early onsets. In these cases, a careful balance between maternal and neonatal risks is needed since a prolonged latency period between PPROM and delivery improves neonatal outcomes, but it could increase the risk of chorioamnionitis [11,12]. The long-term neurodevelopmental outcomes after PPROM will depend on the interaction between gen-environment, and the etiology of some central nervous system injuries that can be found in some children born after very early PPROM remain unclear [8], the shortterm benefits of an expectant and conservative management are well established. We could previously report in our setting [15] an encouraging upward trend in the duration of latency period over the first decade of this century, and a decrease in perinatal mortality associated with PPROM very far from term
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