Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study

Abstract

BackgroundPreterm premature rupture of membranes (PPROM) complicates 1 % of all pregnancies and occurs in one third of all preterm deliveries. Midtrimester PPROM is often followed by spontaneous miscarriage and elective termination of ongoing pregnancies is offered in many countries. The aim of this retrospective descriptive cohort study was to investigate the natural history of midtrimester PPROM in a jurisdiction where termination of pregnancy in the absence of maternal compromise is unavailable.MethodsCases of midtrimester PPROM diagnosed between 14 and 23 + 6 weeks’ gestation during April 2007 to June 2012 were identified following a manual search of all birth registers, pregnancy loss registers, annual reports, ultrasound reports, emergency room registers and neonatal death certificates at Cork University Maternity Hospital - a large (circa 8500 births per annum) tertiary referral maternity hospital in southwest Ireland. Cases where delivery occurred within 24 h of PPROM were excluded.ResultsThe prevalence of midtrimester PPROM was 0.1 % (42 cases/44,667 births). The mean gestation at PPROM was 18 weeks. The mean gestation at delivery was 20 + 5 weeks, with an average latency period of 13 days.Ten infants were born alive (23 %; 10/42). The remainder (77 %; 32/42) died in utero or intrapartum. Nine infants were resuscitated. Two infants survived to discharge. The overall mortality rate was 95 % (40/42).Five women had clinical chorioamnionitis (12 %; 5/42) but 69 % demonstrated histological chorioamnionitis. One woman developed sepsis (2.4 %; 1/42). Other maternal complications included requirement of intravenous antibiotic treatment (38 %; 17/42), retained placenta (21 %, 9/42) and post-partum haemorrhage (12 %; 5/42).ConclusionsThis study provides useful and contemporary data on midtrimester PPROM. Whilst fetal and neonatal mortality is high, long-term survival is not impossible. The increased risk of maternal morbidity necessitates close surveillance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0813-3) contains supplementary material, which is available to authorized users.

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

“…Linehan et al analyzed the neonatal and maternal outcome in women after PPROM, diagnosed between 14 and 23 + 6 weeks' gestation: only 23% of infants were born alive and the overall mortality rate was 95% [88][89][90]. In this study chorioamnionitis was found in 69% and 12% patients developed post-partum hemorrhage [88].…”

Evaluation of Maternal Risk Factors, Delivery, and Neonatal Outcomes of Premature Rupture of Membrane: A Systematic Review Study

“…Out of 44667 deliveries, 42 cases were selected during the five-year study. The prevalence of PPROM in the second trimester of pregnancy was 1 in 1000 pregnancies (26). Yang et al retrospectively reviewed the maternal and fetal outcomes of 73 single-pregnancies with PROM (16 to 26 weeks).…”

Velamentous or marginal cord insertion and the risk of spontaneous preterm birth, prelabor rupture of the membranes, and anomalous cord length, a population‐based study

“…Preterm prelabor rupture of membranes (pPROM) is reported to occur in 30–40% of spontaneous preterm births , whereas PROM (prelabor rupture of the membranes at term) occurs in approximately 8% of term pregnancies . Women with PROM are often hospitalized and induced to minimize the risk and pregnancies with pPROM carry a significant risk of perinatal morbidity and mortality . Several risk factors for pPROM have been identified: infection of the genitourinary tract, prior preterm birth, cerclage placement, bleeding, maternal diabetes, cigarette smoking, and Black race .…”