The dilemma of preterm premature rupture of membranes: Prolongation of pregnancy or delivery?

Purpose: Preterm premature rupture of membranes (PPROM) is a major reason for preterm delivery and subsequent perinatal morbidity and mortality. There is some controversy over the optimal clinical management and time of delivery with PPROM. The analysis of the clinical data of patients with preterm premature rupture of membranes should contribute to this discussion. Material and Methods: We retrospectively analyzed the clinical course and fetal outcome of 178 patients with preterm premature rupture of membranes before 34 weeks of pregnancy in our clinic. Results: 81.2% of patients delivered within one week after rupture of membranes; the median time of prolongation of pregnancy was less than 4 days. In 64% a single course of antenatal corticoid therapy was administered due to a prolongation of at least 48 hours. We found histological signs of chorionamnionitis in 55%. 27.2% of the newborns had clinically proven sepsis; this rate increased with the duration of prolongation. 86.7% of newborns could be discharged home after clinical therapy. Intracerebral hemorrhage grade three and four did not occur in neonates delivered after 30 weeks' gestation. Three newborns died postpartum after delivery at 28 weeks; two of them had complex malformations. Discussion: As the chances of long-term prolongation of the pregnancy after preterm rupture of membranes are low and the likelihood of septic complications in the newborn increases with longer prolongation, early delivery is recommended after preterm rupture of membranes. Due to good neonatal survival and outcome, prolongation for more than 48 hours after the 30th week of pregnancy is questionable.