Premature rupture of membranes before 28 weeks managed expectantly: Maternal and perinatal outcomes in a developing country

Abstract

This study aimed to assess outcomes of expectant management for early preterm premature rupture of membranes (PPROM). This retrospective cohort involved 66 women with PPROM <28 weeks managed in a single hospital (1999-2006). Main outcomes were chorioamnionitis, severe maternal morbidity (maternal sepsis, haemorrhage/blood transfusion, hysterectomy or admission to intensive care unit), maternal mortality, low birth weight, preterm birth, neonatal infection and perinatal mortality. Mean gestational ages at PPROM and delivery were 21.7 ± 4.2 and 28.4 ± 5.9 weeks, respectively. Chorioamnionitis was diagnosed in 47%; no cases of severe maternal morbidity or mortality occurred. Stillbirth rate was 25.7% and >80% of infants were delivered before 34 weeks. Neonatal infection was diagnosed in 42.9% of the 49 live-births. Overall survival rate was 57.6%. Expectant management of PPROM <28 weeks resulted in high rates of chorioamnionitis and preterm deliveries but in over half of the cases, a live infant was discharged home.

The association of the amniotic fluid index (AFI) with perinatal fetal and maternal outcomes in pregnancies complicated by preterm premature rupture of membranes (PPROM)

“…In fact, while oligohydramnios has been associated with a higher likelihood of caesarean section due to non-reassuring fetal heart rate patterns [5,12,20] as well as with longer NICU stay [25], our findings revealed similar cesarean section delivery rates and length of NICU stay in AFI ≥ 5 cm and < 5 cm groups. Nevertheless, caesarean section rate (18.8%) in our cohort of women with pregnancies complicated by PPROM at 23-33 weeks' gestation seems in accordance with the likelihood of an increased risk of maternal infection in cesarean sections, particularly in women at risk of developing chorioamnionitis [23,26].…”

Preterm premature rupture of membranes: Which criteria contraindicate home care management?

“…These criteria had already been highlighted individually in previous studies, particularly for fetal presentation and amniotic fluid quantity . The choice of gestational age threshold was based on the literature . PPROM with complications accounted for 6.4% of the patients in our study.…”

Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes

“…Nevertheless, we must remember that cesarean sections can increase the risk of maternal infection and its complications, particularly in women at risk of developing chorioamnionitis. 5,7,12 Thus, given the rigorous monitoring of these patients it is likely that the rate of perinatal mortality was due to neonatal sepsis and not compression of the umbilical cord. Another point in favor of mortality, as a result of sepsis, is that the risk of neonatal sepsis was equal to the risk of early neonatal death.…”

“…Perinatal mortality was high (18.6%), double that found in a university hospital in Iran, which described a rate of 8.7%, 8 but lower than the 25.7% observed in a university hospital in the southeast of Brazil. 12 The differences in perinatal mortality rates may be due to different conduct protocols for PPROM or even regional differences. It was also observed that when AFI was less than 5.0 cm the risk for perinatal mortality was three times higher.…”