Response to comment from Dr. Ken-ichi Shukunami

Abstract

Thank you for the opportunity to respond to Dr. Ken-ichi Shukunami's letter, in which he pointed out two problems with our study. We agree with him that our article covered only management and mortality, but we believe that our large prospective cohort provides important information for clinicians concerning patients experiencing PPROM. One of the most significant results is the mortality rate presented by gestational age at birth but also by gestational age at rupture with contemporary management including antibiotics and steroids. Dr. Shukunami proposed to exclude from the analysis neonates with pathologies, such as intra-uterine growth restriction or infectious foetopathology. We chose to report data without exclusion to give all the results from an entire region. For PPROM, after 30 weeks in our population-based study, only two neonates died before 28 days of life. We believe that, with this low mortality rate, the exclusion of infants with certain pathologies would not have been more useful. Dr. Shukunami cited the interesting article by Hnat et al. [ [1] Hnat M.D. Mercer B.M. Thurnau G. et al. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Perinatal outcomes in women with preterm rupture of membranes between 24 and 32 weeks of gestation and a history of vaginal bleeding. Am J Obstet Gynecol. 2005; 193: 164-168 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar ], pointing out that reporting perinatal outcomes would be better. First of all, in their article, the primary outcome was not perinatal morbidity but the latency period. Hnat et al. showed that pregnancies complicated by vaginal bleeding before PPROM were at increased risk for abruptio placentae and neonatal respiratory distress syndrome. Second, we believe that it is risky to compare the results of a population-based study with those of a randomised, controlled trial. We have also collected neonatal data in the DOMINOS study and further analysis will be reported. Comment to “A prospective population-based study of 598 cases of PPROM between 24 and 35 weeks’ gestation: Description, management, and mortality (DOMINOS cohort)”European Journal of Obstetrics and Gynecology and Reproductive BiologyVol. 127Issue 2PreviewWe read with great interest the article by Pasquier et al. [1], which described a prospective study of patients with preterm premature rupture of fetal membranes (PPROM) between 24 and 35 weeks’ gestation. We would like to point out two problems with Pasquier's study. First, the research only covered the management and mortality in the study population of 598 cases. In contrast, a similar, recently published article by Hnat et al., which researched 581 cases of PPROM between 24 and 32 weeks’ gestation, also included the history of vaginal bleeding and perinatal outcomes [2]. Full-Text PDF