P11.05: Previable rupture or membranes: effect of amniotic fluid on pregnancy outcome

Abstract

To evaluate pregnancy outcome and the role of the amount of amniotic fluid (AF) in the prognosis of extremely preterm (< 24 weeks) premature rupture of membranes (EPPROM). Women with EPPROM and ongoing pregnancy after one week of expectant management were included. Exclusion criteria: fetal anomalies, termination of pregnancy and spontaneous recovery of AF within the first week. Patients were offered expectant management or a sealing procedure depending on AF quantification assessed twice weekly by the largest vertical pocket (LVP). The effect of the LVP on pregnancy outcome was assessed by a Cox regression model with 2 covariates: an updated time dependent (LVP measurements from rupture to 24 weeks) and a time constant (gestational age at rupture of membranes and sealing procedure). Thirty-seven women were included in the study. The overall survival rate after the neonatal period was 40.5% (15/37) which increased to 62.5% (15/24) in neonates born alive after 24 weeks of gestation. Mean and standard deviation of gestational age at rupture of membranes were 19.0 ( ± 3.8) weeks. Mean and standard deviation of LVP at admission and + 7d of rupture were 15.4 ( ± 11.3) mm and 19.8 ( ± 11.9) mm, respectively. From rupture to 24 weeks, the pooled mean and standard deviation of LVP were 20.5 ( ± 15.4) mm. Multivariate analysis showed that the likelihood for neonate survival increased by 2.5 (95% confidence interval 1.38–4.57) for each 5 mm of LVP during the follow-up from rupture to 24 weeks. After controlling for AF amount, neither gestational age at rupture nor the sealing procedure showed any significant effect on pregnancy outcome. Although the prognosis of EPPROM is poor overall, survival improves as the amount of AF before 24 weeks increases.