Pregnancy Outcome Following Preterm Premature Rupture of the Membranes at Less Than 26 Weeks' Gestation

Abstract

The outcome of 71 singleton pregnancies where premature rupture of the membranes (PROM) occurred at gestations of less than 26 weeks was assessed retrospectively. The incidence of chorioamnionitis was 39.4% and the overall maternal morbidity rate was 53% but there were no long-term maternal sequelae. The latent period from PROM until delivery ranged from less than 12 hours to 77 days, with 41% of women delivering within 1 week. There was no increased risk of infection with increasing latent period. The perinatal mortality was 66.2% (26.7% stillbirths and 39.4% neonatal deaths). There was a 65% chance of a live baby if PROM occurred between 24-26 weeks but only 5 of 40 fetuses (12.5%) survived if PROM occurred before 24 weeks. The use of antibiotics, tocolytics and steroids in an uncontrolled manner is reported. Overall there is little serious risk to the mother if a conservative approach is adopted but only about one-third of such women will take home a live baby.

Repercussões maternas e perinatais da ruptura prematura das membranas até a 26ª semana gestacional

“…Felizmente, a conduta conservadora não impôs risco demasiado para a mãe. O percentual de infecção foi baixo (17,2%), menor, inclusive, que o citado em outras séries 10,14 . A adoção imediata da resolução da gravidez em face da suspeita infecciosa talvez explique nossos resultados diversos.…”

“…A RPM, ocorrendo em gestações com 26 semanas ou menos de idade gestacional, desafia o médico em relação à melhor conduta 1,5,8 . Vários trabalhos mostram resultados pouco satisfatórios com o manejo expectante desses casos [8][9][10] . Entretanto, um trabalho comparou resultados maternos e neonatais do passado e presente e concluiu que o uso profilático antenatal de antibióticos prolongou o período de latência 11 .…”

Premature Rupture of the Membranes: An Evidence-Based Approach to Clinical Care

“…112 Another problem with previable ruptured membranes is the fetal deformation sequence associated with Potter's syndrome. This has been reported with prolonged very early ROM and includes pressure deformities of the limbs and face, 113 contractures, 114 and, most seriously, pulmonary hypoplasia. The incidence of these complications is generally reported to affect 25% of livebirths with preterm PROM prior to 26 weeks, 115,116 but this incidence varies based on the gestational age at the time of ROM and the degree of oligohydramnios.…”

Schwangerschaftsverlauf und kindliches Befinden nach vorzeitigem Blasensprung vor 25 Schwangerschaftswochen - Maternal and Perinatal Outcome after Preterm Premature Rupture of the Membranes (PPROM) before 25 Weeks' Gestation -

“…Es ist festzustellen, dass die Studien zu diesem Thema überwiegend in den achtziger Jahren durchgeführt wurden. Darüber hinaus existieren nur wenige Daten über Schwangerschaften mit einem VBS vor 20 + 0 SSW [1,3,13,14,15,18]. Es war deshalb das Ziel dieser Arbeit, die mütterliche und kindliche Morbidität und Mortalität bei VBS vor 25 SSW unter den Möglichkeiten seit 1990 retrospektiv zu analysieren.…”