Rupture of membranes before the age of viability and birth after the age of viability: comparison of outcomes in a matched cohort study

Abstract

Objective: To compare composite adverse outcome rate of infants <32 weeks gestational age (GA) who were born after preterm premature rupture of membranes (PPROM) at previable gestation to those born without PPROM.Study Design: Retrospective review of prospective collected data for infants discharged between 2004 and 2007 was conducted. Cases were infants with >7 days of PPROM that occurred before 24 weeks. Matched cohort consisted of infants born without PPROM (matched for GA, sex and admission date). Composite adverse outcome was assessed considering death or any of the following three severe morbidities (severe neurological injury, severe retinopathy of prematurity or chronic lung disease).Result: The 29 cases had higher mean severity of illness score compared with 74 matched infants. Mean duration of ROM was 45 vs 2 days and mean GA at the ROM was 21 vs 27 weeks, respectively. Logistic regression confirmed significantly higher risk of composite adverse outcome rates for cases (69 vs 47%; P ¼ 0.02, adjusted odds ratio 4.0, 95% CI 1.2, 13.6). Conclusion:The survival rate for infants born at <32 weeks following PPROM at previable age has improved significantly; however, these infants had a higher rate of adverse composite neonatal outcome.

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

“…Korzeniewski Soylu et al found, that infants with a PPROM history more than 7 days, that occurred before 24 weeks of pregnancy developed RDS in 97% of cases, 21% experienced persistent pulmonary hypertension, 24% had severe intraventricular hemorrhage and the overall mortality rate was 24% [8].…”

“…Surviving children also have higher risks of physical and developmental disabilities, including chronic respiratory disease, neurodevelopmental or behavioral effects (impairment of visual/hearing/executive functioning, global developmental delay and psychiatric/behavioral sequela) and cardiovascular diseases. Prolonged anhydramnion after PPROM is associated with a four-fold increased risk of composite adverse outcomes, including death, BPD, severe neurological disorders, severe retinopathy, when compared to an age-adjusted control group [7,8].…”

Pulmonary Effects of Prolonged Oligohydramnios following Mid-Trimester Rupture of the Membranes – Antenatal and Postnatal Management

“…Despite the reduction in mortality rates, the morbidity remains high, with 40% of survivors developing bronchopulmonary dysplasia (BPD). Infants born following rupture of the membranes prior to 24 weeks and a mean latency to delivery of 45 days had a fourfold increased risk of a composite adverse outcome (death, severe retinopathy of prematurity, BPD and severe neurological injury) when compared to age-adjusted controls [6] . The aim of this review is to evaluate critically the evidence regarding mechanisms of abnormal lung growth in PPROM and the efficacy of antenatal and postnatal diagnostic and therapeutic interventions.…”

Temporal trends of latency period and perinatal survival after very early preterm premature rupture of fetal membranes

“…The perinatal mortality figures associated with very early PPROM (at or before 28 weeks) are high, although in recent years there have been encouraging reports of better neonatal survival rates [11,12].…”