Rotura prematura de membranas en edad gestacional previable

Abstract

Objective To describe neonatal outcomes in preterm premature rupture of membranes (PPROM) before 24 weeks of gestation. Patients and methods Fifty consecutive patients with PPROM before 24 weeks’ gestation were included. If deepest pool of amniotic fluid (DPAF) was < 1.0 cm 1 week after admission, amniopatch was offered. If DPAF was ≥ 1.0 cm, expectant management was followed. Perinatal and maternal outcomes were evaluated. Results The mean gestational age at PPROM was 18.2 weeks (SD ± 3.6). Amniopatch was performed in 13 patients (26%). Of the 50 patients, 15 chose pregnancy termination and 35 were managed expectantly. In these 35 patients, there were 12 (34.3%) fetal demises or non-viable deliveries before 24 weeks, four (11.4%) fetal demises after 24 weeks and four (11.4%) neonatal deaths. A significant inverse relationship was observed between latency period and gestational age at PPROM. Pulmonary hypoplasia occurred in four neonates (11.4%) and chorioamnionitis in eight neonates (22.9%). There was only one case (2.9%) of congenital luxation of the knee. Conclusions The overall perinatal survival rate in pregnancies with rupture of membranes before 24 weeks was 42.9% with a neonatal mortality of 57.1%. However, survival markedly improves when pregnancy is prolonged to over 24 weeks and in our series it increased to 65.2%.