Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation

Objective: A current descriptive assessment of perinatal outcomes in pregnancies complicated by previable preterm premature rupture of membranes (pPPROM) at <24 weeks of gestation, after expectant treatment. Study design: Maternal and short-term neonatal data were collected for patients with pPPROM. Results: Seventy-three patients with 93 fetuses were hospitalized with pPPROM at 15-24 weeks' gestation. Among these patients, 27.4% (n = 20) chose pregnancy termination, 27.4% (n = 20) miscarried and 45.2% (n = 33) proceeded to live births. After a median latency period of 38 days, ranging from 1 to 126 days, 24 singletons and 20 multiples were live-born, of whom 79.5% (n = 35) survived the perinatal period. The main neonatal sequelae were pulmonary hypoplasia (29.5%; n = 13), connatal infection (56.8%; n = 25), intraventricular hemorrhage (25%; n = 11; resulting in five neonatal deaths) and Potter's syndrome (15.9%; n = 7). Nine newborns died, within an average of 2.8 days (range, 1-10 days). The overall neonatal survival rate was 51.5% - including miscarriages but not elective terminations. The intact survival rate was 45.5% of all live-born neonates. Conclusions: Even with limited treatment options, overall neonatal survival is increasing. However, neonatal mortality and morbidity rates remain high. The gestational age at membrane rupture does not predict neonatal outcome.