Objective: To assess the neonatal outcome and four-year follow-up of pregnancies complicated by preterm prelabor rupture of membranes (PPROM) before 24 weeks.
Design: Retrospective study.
Setting: University Hospital of Saint Etienne, tertiary level center, France.
Methods: Obstetric and neonatal records of 38 pregnancies and 44 fetuses born between 1999 and 2004 (six years) with PPROM between 14 and 23 + 6 weeks of gestation were studied. We analyzed spontaneous (group A) and iatrogenic PPROM (Group B) cases, including maternal, fetal, placental, and neonatal characteristics. Surviving infants were followed until the age of four.
Results: Median gestational age at PPROM was 21 weeks [range 15-23 + 6]. Of the 38 women with PPROM, 22 (A) had spontaneous PPROM and 16 (B) underwent an invasive procedure during pregnancy. Expectant management was applied to 25 women: 12 (13 fetuses) from group A and 13 (16 fetuses) from group B. Median latency from PPROM to delivery was 35 days [range 1-163 days]. The two groups showed significant differences. The overall survival rate was 59% (17 fetuses) and three babies from group A died in the hospital. Survival rate of infants discharged from hospital was 48% (14/29). Of 14 surviving infants, 71% had a normal neurological and developmental outcome at four years. Only two infants from group A survived without obvious sequelae.
Conclusion: Pregnancy after iatrogenic PPROM had a better prognosis than after spontaneous PPROM. Intensive management with corticosteroids and antibiotics appeared to be helpful. Neonatal survival in spontaneous PPROM before 24 weeks remained very poor and discussing pregnancy termination in these cases seems legitimate.
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