Outcomes in gestations between 20 and 25 weeks with preterm premature rupture of membranes

Background: Preterm deliveries complicate 11% of all births within the United States. In the urban inner city population, this figure approaches approximately 18%. In one quarter to one third of these deliveries, preterm premature rupture of the membranes (PPROM) has been a causative factor. Objective: The purpose of this study was to evaluate outcomes of pregnancies complicated by preterm premature rupture of membranes at less than or equal to 24 weeks gestation at our institution. Methods: A retrospective review of 300 charts was performed on patients delivered at our institution from December 2003 to December 2004. Patients with gestational ages between 20 and 24 weeks with ruptured membranes were included in the study. Maternal, fetal, placental, and neonatal characteristics were reviewed. Results: A total of 16 infants were delivered. Seven infants were live born. The latency period was 4 days. The mean gestational age was 22 1/7 weeks. The average life span of the live born infants was noted to be 20 days. Chorioamnionitis was demonstrated in 85% of the placental specimens; in 57% of these specimens, group B streptococcus was noted to be the etiologic agent. Of the 16 infants delivered, only one infant is still alive and neurologically intact. Conclusion: Various pathogens have been associated with PPROM and subsequent preterm delivery. The findings of this study suggest that within our population, group B streptococcus appears to be the primary causal agent associated with PPROM. Prevention of infection by early surveillance and patient education may help to decrease the incidence, but further investigation is warranted.