Maternal and perinatal outcome after preterm premature rupture of the membranes (PPROM) before 25 weeks' gestation

Purpose: Evaluation of maternal and perinatal outcome in consecutive gestants with PPROM < 25 weeks' gestation, Material and Methods: Retrospective analysis of the data between 1990 and 1997. Neonatal outcome of babies born with gestational age greater than or equal to 24.0 weeks was compared with controls without PPROM matched for gestational age, birth weight and year. Results: There were 110 gestants with persistent PPROM. The gestational age (median and range) at diagnosis of PPROM was 20.1 (13.7-24.8) weeks. Of these 52 had PPROM before 20 weeks. The latency from PPROM to delivery was 14 (0 to 138) days. Sixty patients (55%) reached a gestational age of greater than or equal to 24 weeks (19/52 gestants with PPROM <20) and had a preterm delivery at 25.8 (24.0-34.3) weeks. Of this 60 infants 10 died in the delivery room because of refusing intervention by the parents or of letal abnormalities. The survival rate in 50 neonates received neonatal care was 76% (11/17 in PPROM < 20 weeks). Mortality (12/50) was caused in 8 cases by respiratory morbidity (6 infants after PPROM < 20 weeks). In infants with PPROM, there was a trend to higher rate of intraventricular hemorrhage (> 11) (31 vs 17%), bronchopulmonary dysplasia (42 vs. 24%) and connatal sepsis (46 vs. 26%) when compared to infants without PPROM (p > 0.05, Fisher's exact test). Conclusion: In spite of PPROM in midtrimester prolongation until 24 weeks' gestation is possible in more than 50%. The neonatal outcome mainly depends on prematurity. This current data can be used for counselling women suffered by PPROM < 25 weeks.