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

  • Verena Kiver ORCID logo EMAIL logo , Vinzenz Boos , Anke Thomas , Wolfgang Henrich und Alexander Weichert
Veröffentlicht/Copyright: 19. August 2017

Abstract

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.

  1. Author’s statement

  2. Conflict of interest: Authors state no conflict of interest.

  3. Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

  4. Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

  5. Disclosure statement: The authors report no conflict of interest. We have not disclosed any information that could reveal the identity of our patients. The authors affirm that this research was conducted in accordance with the ethical standards of all applicable national and institutional committees and of the World Medical Association’s Helsinki Declaration.

References

[1] Yeast JD. Preterm premature rupture of the membranes before viability. Clin Perinatol. 2001;28:849–60.10.1016/S0095-5108(03)00082-4Suche in Google Scholar

[2] Beydoun SN, Yasin SY. Premature rupture of the membranes before 28 weeks: conservative management. Am J Obstet Gynecol. 1986;155:471–9.10.1016/0002-9378(86)90257-7Suche in Google Scholar

[3] Dowd J, Permezel M. Pregnancy outcome following preterm premature rupture of the membranes at less than 26 weeks’ gestation. Aust N Z J Obstet Gynaecol. 1992;32:120–4.10.1111/j.1479-828X.1992.tb01922.xSuche in Google Scholar

[4] Linehan LA, Walsh J, Morris A, Kenny L, O’Donoghue K, Dempsey E, et al. Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study. BMC Pregnancy Childbirth. 2016;16:25.10.1186/s12884-016-0813-3Suche in Google Scholar

[5] Margato MF, Martins GL, Passini Junior R, Nomura ML. Previable preterm rupture of membranes: gestational and neonatal outcomes. Arch Gynecol Obstet. 2012;285:1529–34.10.1007/s00404-011-2179-0Suche in Google Scholar

[6] 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:F207–11.10.1136/adc.2007.118711Suche in Google Scholar

[7] Newman DE, Paamoni-Keren O, Press F, Wiznitzer A, Mazor M, Sheiner E. Neonatal outcome in preterm deliveries between 23 and 27 weeks’ gestation with and without preterm premature rupture of membranes. Arch Gynecol Obstet. 2009;280:7–11.10.1007/s00404-008-0836-8Suche in Google Scholar

[8] N.I.H. Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Statement. 1994;12:1–24.Suche in Google Scholar

[9] Pasquier JC, Bujold E, Rabilloud M, Picaud JC, Ecochard R, Claris O, et al. Effect of latency period after premature rupture of membranes on 2 years infant mortality (DOMINOS study). Eur J Obstet Gynecol Reprod Biol. 2007;135:21–7.10.1016/j.ejogrb.2006.10.020Suche in Google Scholar

[10] Morales WJ, Talley T. Premature rupture of membranes at <25 weeks: a management dilemma. Am J Obstet Gynecol. 1993;168:503–7.10.1016/0002-9378(93)90482-XSuche in Google Scholar

[11] Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Early-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 1996;129:72–80.10.1016/S0022-3476(96)70192-0Suche in Google Scholar

[12] Klinger G, Levy I, Sirota L, Boyko V, Lerner-Geva L, Reichman B. Outcome of early-onset sepsis in a national cohort of very low birth weight infants. Pediatrics. 2010;125:e736–e40.10.1542/peds.2009-2017Suche in Google Scholar

[13] Shatrov JG, Birch SC, Lam LT, Quinlivan JA, McIntyre S, Mendz GL. Chorioamnionitis and cerebral palsy: a meta-analysis. Obstet Gynecol. 2010;116:387–92.10.1097/AOG.0b013e3181e90046Suche in Google Scholar

[14] Ehrenberg HM, Mercer BM. Antibiotics and the management of preterm premature rupture of the fetal membranes. Clin Perinatol. 2001;28:807–18.10.1016/S0095-5108(03)00079-4Suche in Google Scholar

[15] Hutzal CE, Boyle EM, Kenyon SL, Nash JV, Winsor S, Taylor DJ, et al. Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metaanalysis. Am J Obstet Gynecol. 2008;199:620.e1–e8.10.1016/j.ajog.2008.07.008Suche in Google Scholar PubMed

[16] Duff P, Lockwood CJ, Barss VA. Preterm premature (prelabor) rupture of membranes. UpToDate. 2017; Topic 6754 (Version 95.0).Suche in Google Scholar

[17] Waters TP, Mercer BM. The management of preterm premature rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol. 2009;201:230–40.10.1016/j.ajog.2009.06.049Suche in Google Scholar PubMed

[18] 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;131:163–8.10.1016/j.ejogrb.2006.05.016Suche in Google Scholar PubMed

[19] Varma R, James DK. Preterm premature rupture of the membranes at 22 weeks: problem-based approach. Curr Obstet Gynaecol. 2001;11:178–85.10.1054/cuog.2001.0174Suche in Google Scholar

[20] Cobo T, Munros J, Rios J, Ferreri J, Migliorelli F, Banos N, et al. Contribution of amniotic fluid along gestation to the prediction of perinatal mortality in women with early preterm premature rupture of membranes. Fetal Diagn Ther. 2017.10.1159/000475926Suche in Google Scholar PubMed

[21] Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev. 2013:CD001058.10.1002/14651858.CD001058.pub3Suche in Google Scholar PubMed

[22] Ziadeh S, Yahaya A. Pregnancy outcome at age 40 and older. Arch Gynecol Obstet. 2001;265:30–3.10.1007/s004040000122Suche in Google Scholar PubMed

[23] Caughey AB, Robinson JN, Norwitz ER. Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol. 2008;1:11–22.Suche in Google Scholar

[24] Federal committee of justice and consumer protection. Maternity protection policies (in German). 2012.Suche in Google Scholar

[25] Joint federal commitee for maternity guidelines. Maternity guidelines – maternity log (in German). 10.11.2015 ed2015.Suche in Google Scholar

[26] Mackeen AD, Seibel-Seamon J, Grimes-Dennis J, Baxter JK, Berghella V. Tocolytics for preterm premature rupture of membranes. Cochrane Database Syst Rev. 2011:CD007062.10.1002/14651858.CD007062.pub2Suche in Google Scholar

[27] Romero R, Quintero R, Oyarzun E, Wu YK, Sabo V, Mazor M, et al. Intraamniotic infection and the onset of labor in preterm premature rupture of the membranes. Am J Obstet Gynecol. 1988;159:661–6.10.1016/S0002-9378(88)80030-9Suche in Google Scholar

[28] Brookfield KF, El-Sayed YY, Chao L, Berger V, Naqvi M, Butwick AJ. Antenatal corticosteroids for preterm premature rupture of membranes: single or repeat course? Am J Perinat. 2015;32:537–44.10.1055/s-0034-1396690Suche in Google Scholar

[29] Rysavy MA, Li L, Bell EF, Das A, Hintz SR, Stoll BJ, et al. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med. 2015;372:1801–11.10.1056/NEJMoa1410689Suche in Google Scholar

[30] Rotschild A, Ling EW, Puterman ML, Farquharson D. Neonatal outcome after prolonged preterm rupture of the membranes. Am J Obstet Gynecol. 1990;162:46–52.10.1016/0002-9378(90)90818-RSuche in Google Scholar

[31] Chang TC, Yeo SH, Huang HF, Leng JH. Reproducibility of the amniotic fluid index: its effect on clinical practice. Ultrasound Obstet Gynecol. 1995;6:416–20.10.1046/j.1469-0705.1995.06060416.xSuche in Google Scholar PubMed

[32] O’Brien JM, Barton JR, Milligan DA. An aggressive interventional protocol for early midtrimester premature rupture of the membranes using gelatin sponge for cervical plugging. Am J Obstet Gynecol. 2002;187:1143–6.10.1067/mob.2002.127124Suche in Google Scholar PubMed

[33] Locatelli A, Vergani P, Di Pirro G, Doria V, Biffi A, Ghidini A. Role of amnioinfusion in the management of premature rupture of the membranes at <26 weeks’ gestation. American journal of obstetrics and gynecology. 2000;183(4):878–82.10.1067/mob.2000.108873Suche in Google Scholar PubMed

[34] Rodríguez-Trujillo A, Cobo T, Vives I, Bosch J, Kacerovsky M, Posadas DE, et al. Gestational age is more important for short-term neonatal outcome than microbial invasion of the amniotic cavity or intra-amniotic inflammation in preterm prelabor rupture of membranes. Acta Obstet Gynecol Scand. 2016;95:926–33.10.1111/aogs.12905Suche in Google Scholar PubMed

[35] Kilpatrick SJ, Patil R, Connell J, Nichols J, Studee L. Risk factors for previable premature rupture of membranes or advanced cervical dilation: a case control study. Am J Obstet Gynecol. 2006;194:1168–74.10.1016/j.ajog.2005.12.017Suche in Google Scholar PubMed

[36] Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010;110:1368–73.10.1213/ANE.0b013e3181d74898Suche in Google Scholar

[37] Seaward PG, Hannah ME, Myhr TL, Farine D, Ohlsson A, Wang EE, et al. International multicentre term prelabor rupture of membranes study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. Am J Obstet Gynecol. 1997;177:1024–9.10.1016/S0002-9378(97)70007-3Suche in Google Scholar

[38] Dinsmoor MJ, Bachman R, Haney EI, Goldstein M, MacKendrick W. Outcomes after expectant management of extremely preterm premature rupture of the membranes. Am J Obstet Gynecol. 2004;190:183–7.10.1016/S0002-9378(03)00926-8Suche in Google Scholar

[39] Farooqi A, Holmgren PA, Engberg S, Serenius F. Survival and 2-year outcome with expectant management of second-trimester rupture of membranes. Obstet Gynecol. 1998;92:895–901.Suche in Google Scholar

[40] Petit N, Cammu H, Martens G, Papiernik E. Perinatal outcome of twins compared to singletons of the same gestational age: a case-control study. Twin Res Hum Genet. 2011;14:88–93.10.1375/twin.14.1.88Suche in Google Scholar PubMed

[41] 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: 992–8.10.1097/AOG.0000000000000511Suche in Google Scholar PubMed

[42] Hibbard JU, Hibbard MC, Ismail M, Arendt E. Pregnancy outcome after expectant management of premature rupture of the membranes in the second trimester. J Reprod Med. 1993;38:945–51.Suche in Google Scholar

Received: 2016-10-25
Accepted: 2017-7-11
Published Online: 2017-8-19
Published in Print: 2018-7-26

©2018 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. A transformative icon for modern perinatology
  4. Highlight: Preterm Labor
  5. Editorial
  6. What’s new in preterm birth prediction and prevention?
  7. Review articles
  8. Pulmo uterinus: a history of ideas on fetal respiration
  9. Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome
  10. Highlight articles
  11. A soft cervix, categorized by shear-wave elastography, in women with short or with normal cervical length at 18–24 weeks is associated with a higher prevalence of spontaneous preterm delivery
  12. Association between genital mycoplasmas, acute chorioamnionitis and fetal pneumonia in spontaneous abortions
  13. Methylation differences reveal heterogeneity in preterm pathophysiology: results from bipartite network analyses
  14. Understanding fetal factors that contribute to preterm birth: Sjögren-Larsson syndrome as a model
  15. Safety and efficacy of the cervical pessary combined with vaginal progesterone for the prevention of spontaneous preterm birth
  16. Risk of preterm birth by maternal age at first and second pregnancy and race/ethnicity
  17. Infant mortality and causes of death by birth weight for gestational age in non-malformed singleton infants: a 2002–2012 population-based study
  18. Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation
  19. Letter to the Editor
  20. Fundal pressure: risk factors in uterine rupture. The issue of liability: complication or malpractice?
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