Outcome of pregnancies with preterm prelabor rupture of membranes before 27 weeks¡¯ gestation: a retrospective cohort study

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• 作者：Jantien L. van der Heyden ; David P. van der Ham ; S ; er van Kuijk ; Kim J.B. Notten ; Timothy Janssen ; Jan G. Nijhuis ; Christine Willekes ; Martina Porath ; Joris A. van der Post ; Feico Halbertsma ; Ben Willem J. Mol ; Eva Pajkrt
• 关键词：Preterm birth ; Preterm rupture of membranes ; Midtrimester PPROM ; Perinatal mortality ; Neonatal morbidity
• 刊名：European Journal of Obstetrics and Gynecology and Reproductive Biology
• 出版年：2013
• 出版时间：September, 2013
• 年：2013
• 卷：170
• 期：1
• 页码：125-130
• 全文大小：473 K

文摘

Objective

Preterm prelabor rupture of membranes (PPROM) before 27 weeks¡¯ gestation is associated with severe perinatal complications, but quantitative estimates are lacking. The aim of this study was to report and predict outcomes of pregnancies complicated by early PPROM and to study antepartum risk factors that might predict perinatal death in future patients.

Study design

We performed a retrospective cohort study of women with PPROM between 13⁺⁰ weeks and 27⁺⁰ weeks¡¯ gestation between 1994 and 2009 in three perinatal centers.

Main outcome measures

Perinatal mortality, composite neonatal morbidity and premature delivery. A model to predict these outcomes was developed from antepartum variables.

Results

We identified 314 women with PPROM before 27 weeks, including 28 multiple pregnancies. Six pregnancies (2 % ) were terminated before 24 weeks¡¯ gestation, and three were lost to follow up, leaving 305 pregnancies for analysis. Overall, there were 166 perinatal deaths (49 % ). The perinatal mortality rate decreased with increasing gestational age at PPROM (from 70 % in the group PPROM 13-20 weeks to 27 % in the group PPROM 24-27 weeks). Of the 170 surviving neonates, 70 suffered from serious morbidity (41 % ). Early gestational age at PPROM, long interval between PPROM and birth and positive vaginal culture (any bacteria) were associated with perinatal mortality.

Conclusion

Perinatal mortality in PPROM before 27 weeks occurred in half of the cases and among those who survive approximately 40 % suffered serious morbidity. Antenatal parameters can be helpful to predict perinatal mortality.