Outcomes of Pregnancies Complicated by Preterm Premature Rupture of Membranes Before and After 24 Gestational Weeks: A Retrospective Analysis

Abstract

Objective: Preterm premature rupture of membranes (PPROM) complicates 1-5% of pregnancies. Data regarding the outcomes and prognostic factors of pregnancies with pre-viable PPROM (before 24 weeks of gestation) are relatively limited and vary. Therefore, we aimed to evaluate outcomes of PPROM and compare outcomes before and after 24 weeks of pregnancy. Material and Methods: This is a retrospective cohort study that spanned September 1, 2018 to September 30, 2020 at a tertiary hospital. Pregnant women who experienced PPROM between 12 and 33 6/7 weeks were included. Data on maternal obstetric and clinical characteristics, fetal and neonatal characteristics were compared in PPROM occurred before (n=42) and after (n=92) 24 gestational weeks groups. Results: Demographic data were similar for both groups. There were no cases of maternal sepsis and death in either group. Intrauterine death, retention products, necrotizing enterocolitis (NEC), and bronchopulmonary dysplasia (BPD) rates were significantly higher in PPROM occurring before 24 weeks of gestation. A logistic regression analysis showed that significant predictors of survival at discharge were gestational age at diagnosis, corticosteroid prophylaxis for fetal lung maturation, and delivery route. Multivariable regression analysis showed that the only independent predictor for survival rate at discharge was gestational age at diagnosis (odds ratio: 1.34, 95% confidence interval: 1.13, 1.19, p=0.001). Conclusion: Expectant management in pregnancies complicated by PPROM between 12 and 23 6/7 weeks of gestation is associated with an overall neonatal survival rate of 33.3%, high risk of BPD and NEC among survivors, and does not carry severe maternal risks.