Prise en charge et issues des grossesses compliquées d’une rupture prématurée des membranes avant 26 semaines d’aménorrhée

Abstract

ObjectiveTo evaluate short-term outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) before 26 weeks of gestation (wg). Patients and methodsForty patients were included in a retrospective study from 1998 to 2008. ResultsFifty percent of PPROM occurred before 23wg. Survival rate was 21.4% when PPROM occurred before 22wg versus 54.5% when it occurred between 22 and 23+6wg and reached 80% after 24wg (P=0.006). Perinatal mortality affected more frequently primigravida women (OR=5.16; IC95%[0.99–36.59]). Invasive procedures before PPROM did not affect survival rates. Smoking induced shorter latency (19.1±13.8 vs. 40.3±2.3j; P=0.01). Chorioamnionitis complicated all pregnancies terminated before 26wg versus 50% of pregnancies terminated after 26wg (P=0.02). In case of chorioamnionitis, 70% of the germs were identified prenatally. Patients whose CRP was higher than 6mg/L at the time of PPROM had a higher fetal mortality rate (63.6% vs. 27.8%; P=0.02; OR=4.3; IC95%[0,99–22,1]). No significant difference was found in the occurrence of chorioamnionitis based on gestational age at PPROM, result of the vaginal swab on admission or the amount of amniotic fluid. Discussion and conclusionThe gestational age of PPROM and the one of delivery are the major prognostic factors. Primigravida women are more exposed to perinatal mortality. CRP appears to be a predictive factor of perinatal mortality.