Maternal and Neonatal Outcomes of Preterm Premature Rupture of Membranes before Viability

Abstract

Background: To investigate maternal and neonatal outcomes of previable preterm premature rupture of membranes (PPROM) and compare outcome between previable PPROM before and after 20 weeks of pregnancy, with data from one single center.

Patients: All women with singleton or twin pregnancies, from 2002 through 2011, who presented with PPROM before 24 weeks of gestation.

Method: A retrospective cohort study in a university teaching hospital in the Netherlands. Data were analyzed and compared between pregnancies with previable PPROM before and after 20 weeks of pregnancy. Main outcome measures were maternal and neonatal morbidity and mortality.

Results: A total of 160 women (164 fetuses) were included. 90 women (56.2%) developed complications (intra-uterine infection, retained placenta, placental abruption or sepsis). There was no maternal mortality. 68 neonates were admitted after birth. PPHN (64.7%, p=0.001) and contractures (58.8%, p<0.001) occurred significantly more in neonates born after PPROM<20 weeks of pregnancy. Eventually 38.4% of the neonates survived. Neonates born after previable PPROM > 20 weeks had a greater likelihood of being alive at discharge (22.7 vs. 46.9%, p=0.008).

Discussion: This study of previable PPROM shows that more than 50% of the mothers develop one or more complications. Neonates have a high mortality rate, especially neonates born after PPROM<20 weeks of pregnancy. In particular neonates born after PPROM<20 weeks of pregnancy should be watched closely for PPHN and contractures.

Conclusion: This large single center study can provide good foundation for counseling parents on previable PPROM, especially the prognosis of PPROM<20 weeks of pregnancy is of additional value.

Zusammenfassung

Hintergrund: Es wurden das maternale und das neonatale Outcome bei Schwangerschaften mit einem vorzeitigen Blasensprung (PPROM) untersucht und ein Vergleich zwischen PPROM vor und nach 20 Schwangerschaftswochen mit Daten von einem einzigen Zentrum angestellt.

Patienten: Einlings- und Zwillingsschwangerschaften, die im Zeitraum von 2002 und 2011 in einem tertiären Perinatalzentrum aufgrund eines PPROM vor 24 Schwangerschaftswochen behandelt wurden.

Methoden: Retrospektive Level III Kohortenstudie in den Niederlanden. Primäres Outcome waren maternale und neonatale Morbidität und Mortalität.

Resultate: Es wurden 160 Schwangere (164 Feten) inkludiert. Neunzig Schwangere (56.2%) entwickelten Komplikationen. Es gab keine Müttersterblichkeit. Auf der NICU wurden 68 Neonaten stationär behandelt. PPHN (64.7%, p=0.001), Kontrakturen (58.8%, p<0.001) wurden signifikant mehr diagnostiziert nach PPROM<20 Wochen. Schließlich überlebten 38.4% der Neugeborenen. Neugeborene, geboren nach previable PPROM>20 Wochen geboren hatten eine größere Wahrscheinlichkeit bei der Entlassung am Leben zu sein (22,7 vs. 46,9%, p=0,008).

Diskussion: Diese Studie zeigt, dass bei mehr als 50% der Mütter Komplikationen auftreten. Die Neonaten haben eine hohe Mortalitätsrate, besonders die mit PPROM vor 20 Wochen. Insbesondere Neugeborene, geboren nach PPROM<20 Wochen, sollten engmaschig auf PPHN und Kontrakturen beobachtet werden.

Schlussfolgerung: Diese große monozentrischen Studie kann eine gute Grundlage für die Beratung von Eltern auf PPROM darstellen. Insbesondere ist die Prognose von PPROM<20 Wochen ein Mehrwert.

Key words

previable PPROM - outcome - morbidity - mortality

Schlüsselwörter

Extrem vorzeitiger Blasensprung - Outcome - Morbidität - Mortalität

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