Neonatal and Maternal Outcomes of Previable Preterm Prelabour Rupture of Membranes: a 10- Year Retrospective Cohort Study

Abstract

Introduction: To evaluate the neonatal survival rate and maternal and neonatal morbidities after conservative treatment for previable preterm prelabour rupture of membranes (PPROM) at our hospital over the past 10 years.
Methods: Maternal and neonatal records of women with PPROM before 24 weeks who delivered at Princess Margaret Hospital between 1 April 2007 and 31 March 2017 were retrospectively reviewed. Patients with PPROM before 20 weeks of gestation were compared with those with PPROM between 20 and 23+6 weeks of gestation. The primary outcome was neonatal survival rate until discharge. Secondary fetal/neonatal outcomes included the live birth rate, latency period, gestational age at delivery, and short- and long-term neonatal complications of survivors.
Secondary maternal outcomes included chorioamnionitis, placental abruption, cord prolapse, caesarean section, postpartum haemorrhage, maternal intensive care unit admission, hysterectomy, and maternal death.
Results: Of 80 women (77 singleton and 3 twin pregnancies), 30 opted for pregnancy termination and 50 opted for conservative management. Of the latter, 18 and 32 had PPROM before 20 weeks and between 20 and 23+6 weeks of gestation, respectively. Maternal characteristics of the two groups were comparable. The mean gestational age at PPROM was 20.2 weeks and the mean latency period was 16 days. The overall neonatal survival rate until discharge was 32.1% (n=17); it was lower in women with PPROM before 20 weeks of gestation than after 20 weeks of gestation (10.5% vs. 44.1%, p=0.012). The surviving neonates had various neonatal complications including
respiratory distress syndrome (100%), probable or confirmed neonatal sepsis (81.8%), bronchopulmonary dysplasia (59.1%), and intraventricular haemorrhage (31.8%). Maternal complications included caesarean section (71.4%) and chorioamnionitis (26%).
Conclusions: The prognosis of PPROM remains grave, with only one third of neonates surviving to discharge. The neonatal complication rate remains high for survivors.