Perinatology.  2019 Dec;30(4):193-199. 10.14734/PN.2019.30.4.193.

Perinatal Outcomes Following Prolonged Preterm Premature Rupture of Membranes before Limit of Viability - A Single Center Experience

Affiliations
  • 1Department of Pediatrics, Keimyung University Dongsan Medical Center, Daegu, Korea. jhpark.neo@gmail.com
  • 2Department of Obstetrics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, Korea.

Abstract


OBJECTIVE
To investigate maternal and neonatal outcomes following prolonged preterm premature rupture of membrane (PPROM) before limit of viability in a single center.
METHODS
Thirty-two women with PPROM before 25 weeks' gestation without overt intrauterine infection were administered expectant management. We investigated maternal and neonatal outcomes of pregnancies following PPROM occurring before 25 weeks' gestation and with latent period (from membrane rupture to delivery) of 7 days or more.
RESULTS
Median gestational age at membrane rupture was 22.1 weeks. Median latent period was 32 days. Median gestational age at delivery was 26.6 weeks. The incidence of clinical pulmonary hypoplasia and early onset sepsis was 43.5% (10/23) and 21.7% (5/23), respectively. The overall mortality in neonatal intensive care unit (NICU) was 43.5% (10/23). Latent period was negatively correlated with gestational age at membrane rupture (r=−0.501, P=0.015), but not associated with maternal complications. As the length of latent period increased, overall mortality in NICU decreased (relative risk=0.898, P=0.011).
CONCLUSION
The expectant management in women with PPROM before 25 weeks' gestation did not induce maternal complications and might help to improve the neonatal outcomes rather than the immediate delivery.

Keyword

Fetal membranes, premature rupture; Pregnancy maintenance; Pregnancy complications; Infant mortality

MeSH Terms

Female
Fetal Membranes, Premature Rupture
Gestational Age
Humans
Incidence
Infant
Infant Mortality
Infant, Newborn
Intensive Care, Neonatal
Membranes*
Mortality
Pregnancy
Pregnancy Complications
Pregnancy Maintenance
Rupture*
Sepsis

Figure

  • Fig. 1. Flowchart of pregnant women and infants with PPROM before 25 weeks of gestation. PPROM, prolonged preterm premature rupture of membrane; GA, gestaional age; NICU, neonatal intensive care unit.


Reference

References

1. Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol. 2003; 101:178–93.
Article
2. Melamed N, Hadar E, Ben-Haroush A, Kaplan B, Yogev Y. Factors affecting the duration of the latency period in preterm premature rupture of membranes. J Matern Fetal Neonatal Med. 2009; 22:1051–6.
Article
3. Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev. 2010; 8:CD001058.
Article
4. Garite TJ, Freeman RK. Chorioamnionitis in the preterm gestation. Obstet Gynecol. 1982; 59:539–45.
5. Beydoun SN, Yasin SY. Premature rupture of the membranes before 28 weeks: conservative management. Am J Obstet Gynecol. 1986; 155:4719.
Article
6. American College of Obstetrics and Gynecology. ACOG practice bulletin. Perinatal care at the threshold of viability. Number 38, September 2002. American College of Obstetrics and Gynecology. Int J Gynaecol Obstet. 2002; 79:181–8.
7. Yeast JD. Preterm premature rupture of the membranes before viability. Clin Perinatol. 2001; 28:849–60.
Article
8. Taylor J, Garite TJ. Premature rupture of membranes before fetal viability. Obstet Gynecol. 1984; 64:615–20.
9. Major CA, Kitzmiller JL. Perinatal survival with expectant management of midtrimester rupture of membranes. Am J Obstet Gynecol. 1990; 163:838–44.
Article
10. Xiao ZH, André P, Lacaze-Masmonteil T, Audibert F, Zupan V, Dehan M. Outcome of premature infants delivered after prolonged premature rupture of membranes before 25 weeks of gestation. Eur J Obstet Gynecol Reprod Biol. 2000; 90:67–71.
Article
11. Muris C, Girard B, Creveuil C, Durin L, Herlicoviez M, Dreyfus M. Management of premature rupture of membranes before 25 weeks. Eur J Obstet Gynecol Reprod Biol. 2007; 131:163–8.
Article
12. Manuck TA, Eller AG, Esplin MS, Stoddard GJ, Varner MW, Silver RM. Outcomes of expectantly managed preterm premature rupture of membranes occurring before 24 weeks of gestation. Obstet Gynecol. 2009; 114:29–37.
Article
13. Williams O, Hutchings G, Debieve F, Debauche C. Contemporary neonatal outcome following rupture of membranes prior to 25 weeks with prolonged oligohydramnios. Early Hum Dev. 2009; 85:273–7.
14. Brumbaugh JE, Colaizy TT, Nuangchamnong N, O'Brien EA, Fleener DK, Rijhsinghani A, et al. Neonatal survival after prolonged preterm premature rupture of membranes before 24 weeks of gestation. Obstet Gynecol. 2014; 124:992–8.
Article
15. Kibel M, Asztalos E, Barrett J, Dunn MS, Tward C, Pittini A, et al. Outcomes of pregnancies complicated by preterm premature rupture of membranes between 20 and 24 weeks of gestation. Obstet Gynecol. 2016; 128:313–20.
Article
16. Kilbride HW, Thibeault DW. Neonatal complications of preterm premature rupture of membranes. Pathophysiology and management. Clin Perinatol. 2001; 28:761–85.
Article
17. Kilbride HW, Yeast J, Thibeault DW. Defining limits of survival: lethal pulmonary hypoplasia after midtrimester premature rupture of membranes. Am J Obstet Gynecol. 1996; 175:675–81.
Article
18. Everest NJ, Jacobs SE, Davis PG, Begg L, Rogerson S. Outcomes following prolonged preterm premature rupture of the membranes. Arch Dis Child Fetal Neonatal Ed. 2008; 93:F207–11.
Article
19. Rotschild A, Ling EW, Puterman ML, Farquharson D. Neonatal outcome after prolonged preterm rupture of the membranes. Am J Obstet Gynecol. 1990; 162:46–52.
Article
20. Winn HN, Chen M, Amon E, Leet TL, Shumway JB, Mostello D. Neonatal pulmonary hypoplasia and perinatal mortality in patients with midtrimester rupture of amniotic membranes–a critical analysis. Am J Obstet Gynecol. 2000; 182:1638–44.
Article
21. Waters TP, Mercer BM. The management of preterm premature rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol. 2009; 201:230–40.
Article
22. Lee J, Romero R, Kim SM, Chaemsaithong P, Park CW, Park JS, et al. A new antimicrobial combination prolongs the latency period, reduces acute histologic chorioamnionitis as well as funisitis, and improves neonatal outcomes in preterm PROM. J Matern Fetal Neonatal Med. 2016; 29:707–20.
Article
23. Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin No. 188: prelabor rupture of membranes. Obstet Gynecol. 2018; 131:e1–14.
24. Gibbs RS, Romero R, Hillier SL, Eschenbach DA, Sweet RL. A review of premature birth and subclinical infection. Am J Obstet Gynecol. 1992; 166:1515–28.
Article
25. Redline RW, Faye-Petersen O, Heller D, Qureshi F, Savell V, Vogler C. Amniotic infection syndrome: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol. 2003; 6:435–48.
Article
26. Zaichkin JG. Neonatal resuscitation: neonatal resuscitation program 7th edition practice integration. Crit Care Nurs Clin North Am. 2018; 30:53347.
27. Suzuki K. Respiratory characteristics of infants with pulmonary hypoplasia syndrome following preterm rupture of membranes: a preliminary study for establishing clinical diagnostic criteria. Early Hum Dev. 2004; 79:31–40.
Article
28. Hadi HA, Hodson CA, Strickland D. Premature rupture of the membranes between 20 and 25 weeks' gestation: role of amniotic fluid volume in perinatal outcome. Am J Obstet Gynecol. 1994; 170:1139–44.
Article
29. Joshi S, Kotecha S. Lung growth and development. Early Hum Dev. 2007; 83:789–94.
Article
30. McMurtry IF. Introduction: pre-and postnatal lung development, maturation, and plasticity. Am J Physiol Lung Cell Mol Physiol. 2002; 282:L341–4.
31. Singh K, Mercer B. Antibiotics after preterm premature rupture of the membranes. Clin Obstet Gynecol. 2011; 54:344–50.
Article
32. Bromiker R, Ernest N, Meir MB, Kaplan M, Hammerman C, Schimmel MS, et al. Correlation of bacterial type and antibiotic sensitivity with maternal antibiotic exposure in early-onset neonatal sepsis. Neonatology. 2013; 103:48–53.
Article
Full Text Links
  • PN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr