Obstetric and Perinatal Outcomes after Very Early Preterm Premature Rupture of Membranes (PPROM)-A Retrospective Analysis over the Period 2000–2020

Background and Objectives: Pre-term premature rupture of membranes (PPROM) responds for one third of preterm births, and it is associated with other complications that increase the risk of maternal or fetal poor outcome. To reduce uncertainty and provide accurate information to patients, the analysis of the large series is of great importance. In order to learn about the evolution over the time of the obstetric and perinatal outcomes in cases of PPROM at, or before, 28 weeks (very early PPROM) managed with an expectant/conservative protocol, we have designed the present study. Materials and Methods: We retrospectively studied all cases of very early PPROM attended in Malaga University Regional Hospital from 2000 to 2020. Results: Among 119888 deliveries assisted, 592 cases of PPROM occurred in pregnancies at or before 28 weeks (0.49% of all deliveries, 3.9% of all preterm births and 12.9% of all cases of PPROM). The mean duration of the latency period between PPROM and delivery was 13.5 days (range 0 to 88 days), enlarging over the years. The mean gestational age at delivery was 27 weeks (SD 2.9; range 17–34). The proportion of cesarean deliveries was 52.5%. The overall perinatal mortality rate was 26.5%, decreasing over the period with a significant correlation Pearson’s coefficient −0.128 (p < 0.05). Conclusions: In the period 2000–2020, there was an improvement in the outcomes of very early PPROM cases and perinatal mortality showed a clear trend to decrease.

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Maternal and perinatal outcome in preterm premature rupture of membranes

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172339 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2498

Author(s):

Jameela Diraviyam M. V. ◽

Lalithambica Karunakaran

Keyword(s):

Perinatal Mortality ◽

Conservative Management ◽

Perinatal Outcome ◽

Latency Period ◽

Perinatal Outcomes ◽

Preterm Births ◽

Perinatal Complications ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture

Background: Preterm premature rupture of membranes (PPROM) occurs in 3% of pregnancies and is responsible for approximately one third of all preterm births. Objective of present study was to analyse the maternal and perinatal outcome of PPROM patients between 28 to 36 weeks +6daysMethods: A descriptive study was conducted on 141 antenatal patients between 28 to 36weeks+6days with PPROM admitted to Department of Obstetrics and Gynecology, Government TD Medical College, Alappuzha, Kerala, India from September 2014 to September 2015. After establishing the diagnosis of PPROM patients were monitored and Maternal and perinatal outcomes were studied.Results: 77% patients had late PPROM. 60% of early PPROM latency period >24 hrs and were managed conservatively till 34 weeks. 18% had chorioamnionitis and immediate termination of pregnancy. 73% of newborns in this group needed admission due to complications of prematurity like RDS (54.54%). Perinatal mortality (2.12%) was due to sepsis. 80% of late PPROM had latency period <24 hrs and only 4% had chorioamnionitis.18.5% babies in this group had hyperbilirubinemia. There was statistically significant association between latency period and perinatal complications (p=0.001). RDS was 33% in latency period <24hrs, 18% in >24hrs and sepsis was 36% in >24hrs and 10% in <24hrs.Conclusions: The most common cause of perinatal mortality in early PPROM is prematurity and its complications. Hence conservative management to prolong pregnancy is recommended under strict monitoring for evidence of chorioamnionitis. At the earliest evidence of chorioamnionitis termination irrespective of gestational age is warranted. In late PPROM, perinatal outcome is good. So, termination is advised as conservative management shall add to the fetal and maternal morbidity due to sepsis.

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

Journal of Perinatal Medicine ◽

10.1515/jpm-2016-0341 ◽

2018 ◽

Vol 46 (5) ◽

pp. 555-565 ◽

Cited By ~ 13

Author(s):

Verena Kiver ◽

Vinzenz Boos ◽

Anke Thomas ◽

Wolfgang Henrich ◽

Alexander Weichert

Keyword(s):

Survival Rate ◽

Pregnancy Termination ◽

Treatment Options ◽

Latency Period ◽

Perinatal Outcomes ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Mortality And Morbidity ◽

Membrane Rupture ◽

Preterm Premature Rupture

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.

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Perinatal Outcomes of Twin Pregnancies With Preterm Premature Rupture of the Membranes at 24–34 Weeks’ Gestation

10.21203/rs.3.rs-669989/v1 ◽

2021 ◽

Author(s):

Shuwei Zhou ◽

Yajun Yang ◽

XiaoYan Zhang ◽

Xiaoling Mu ◽

Quan Quan ◽

...

Keyword(s):

Neonatal Death ◽

Latency Period ◽

Perinatal Outcomes ◽

Neonatal Morbidity ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Factors Associated ◽

Preterm Premature Rupture ◽

Adverse Perinatal Outcomes ◽

Twin Pregnancies

Abstract Objective: To describe the perinatal outcomes of twin pregnancies with preterm premature rupture of membranes (PPROM) before 34 weeks’ gestation and identify factors associated with discharge without severe or moderate-severe neonatal morbidity.Methods: This study was conducted as a retrospective analysis of twin pregnancies with PPROM occurring at 24 0/7 to 33 6/7 weeks’ gestation. Perinatal outcomes were assessed by gestational age (GA) at PPROM. Factors associated with discharge without severe or moderate-severe neonatal morbidity were identified using logistic regression analysis.Results: Of the 180 pregnancies (360 foetuses), only 17 (9.4%) women remained pregnant 7 days after PPROM. There were 10 (2.8%) cases of prenatal or neonatal death; 303 (84.2%) and 177 (49.2%) neonates were discharged without severe or moderate-severe morbidity, respectively. As GA at PPROM increased, the adverse obstetric and neonatal outcomes decreased, especially after 32 weeks. The GA at PPROM and latency period were both significantly associated with discharge without severe or moderate-severe neonatal morbidity. Pregnancy complications and 5-min Apgar score < 7 increased severe neonatal morbidity.Conclusion: As GA at PPROM increased, the risk of adverse perinatal outcomes decreased. GA at PPROM and latency period were significantly associated with discharge without severe or moderate-severe neonatal morbidity.

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Short Term Outcomes of Neonates Born after Prolonged Premature Rupture of Membranes < 34 Weeks Gestation

Research in Health Science ◽

10.22158/rhs.v4n2p83 ◽

2019 ◽

Vol 4 (2) ◽

pp. 83

Author(s):

Isam Bsisu ◽

Alaa Aldalaeen ◽

Rawan Elrajabi ◽

Ala AlZaatreh ◽

Rama Jadallah ◽

...

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Preterm Births ◽

University Hospital ◽

High Rate ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Gestational Week ◽

The Mean

Background: Preterm premature rupture of membranes (PPROM) is responsible for one?third of all preterm births worldwide. This aim of this study was to investigate the outcome of neonates born after prolonged PPROM with gestational age below 34 weeks. Materials and methods: This retrospective study included 65 patients who were born to mothers with Prolonged PPROM <34 weeks gestation between January 2011 and December 2015 and admitted to the neonatal intensive care unit (NICU) at Jordan University Hospital. Results: The mean gestational age of included patients was (31.9 ± 2.5 weeks), mean birth weight was (1840 ± 583 g) and 43 (66.2%) were males. The mortality rate in those infants was 12.3 %. Gestational age, birth weight, and Apgar score were significantly lower among mortality cases compared to surviving cases (P < 0.05). Conclusion: Prolonged PPROM before the 34th gestational week is associated with high rate of morbidity and mortality, for which early identification of risk factors for developing PPROM can help in reducing the risk for preterm labors and subsequent burden on healthcare system.

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The Effect of Transabdominal Amnioinfusion on Perinatal Outcomes in Preterm Premature Rupture of Membranes

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1263 ◽

2014 ◽

Vol 6 (1) ◽

pp. 28-32

Author(s):

Nasira Tasnim ◽

Ghazala Mahmud ◽

Saba Fatima

Keyword(s):

Controlled Trial ◽

Latency Period ◽

Perinatal Outcomes ◽

Expectant Management ◽

Management Control ◽

Control Group ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Significant Prolongation

ABSTRACT Objective To evaluate the role of transabdominal amnioinfusion in improving the latency period and perinatal outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM). Materials and methods A randomized controlled trial was carried out at MCH Centre, Unit I, PIMS, Islamabad, from Jan 2008 to Dec 2008. Sixty women with singleton pregnancies between 28 and 32 completed weeks of gestation, complicated with PPROM was randomly allocated into two groups viz transabdominal amnioinfusion (amnioinfusion group) and expectant management (control group), within 24 hours of admission. Results The demographic characteristics were comparable in both the groups. Amnioinfusion group showed significant improvement in PPROM to delivery interval (18.47 ± 6.699 vs 8.93 ± 4.741 days; p = 0.001), neonatal birth weight (p = 0.019) and Apgar scores at 1 and 5 minutes (p = 0.007 for 1 minute and p = 0.012 for 5 minutes). There was less frequency of respiratory distress syndrome (p = 0.032), neonatal sepsis (p = 0.020) and neonatal jaundice (p = 0.002) in the amnioinfusion group. Fewer neonates were admitted to NICU (p = 0.010) and higher survival rate was found in amnioinfusion group (p = 0.023). Conclusion The treatment with transabdominal amnioinfusion in pregnancies complicated with PPROM resulted in significant prolongation of pregnancy and better neonatal outcomes as compared to women who were managed with traditional expectant management. How to cite this article Fatima S, Tasnim N, Mahmud G. The Effect of Transabdominal Amnioinfusion on Perinatal Outcomes in Preterm Premature Rupture of Membranes. J South Asian Feder Obst Gynae 2014;6(1):28-32.

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The effects of oligohydramnios on perinatal outcomes after preterm premature rupture of membranes

Perinatal Journal ◽

10.2399/prn.21.0291005 ◽

2021 ◽

Vol 29 (1) ◽

pp. 27-32

Author(s):

Subhashini Ladella ◽

David Lee ◽

Fatemeh Abbasi ◽

Brian Morgan

Keyword(s):

Amniotic Fluid ◽

Medical Center ◽

Predictor Variable ◽

Latency Period ◽

Perinatal Outcomes ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Apgar Scores ◽

Preterm Premature Rupture ◽

Adverse Perinatal Outcomes

Objective Amniotic fluid plays a vital protective role in fetal growth and development. Low amniotic fluid index (AFI) during pregnancy increases risk of adverse perinatal outcomes. Prior studies reported association of oligohydramnios (AFI<5 cm) with shorter latency period and inconsistent correlation with chorioamnionitis after preterm premature rupture of membranes (PPROM). We studied effects of oligohydramnios on perinatal outcomes after PPROM. Methods A retrospective cross-sectional study was performed at our medical center on women with PPROM between 23 to 34 weeks during 2014 to 2016. The primary predictor variable was AFI of <5 cm or ≥5 cm in relationship to perinatal outcomes. Results From a total of 117 PPROM cases reviewed, 46 women had AFI<5 cm and 71 had AFI≥5 cm. Length of stay (LOS) in neonatal intensive care unit (NICU) was 42 days for AFI<5 cm versus 26.5 days for AFI>5 cm (p<0.007). The mean neonatal Apgar scores at 1 and 5 minutes (5.2 and 7.4 respectively) were lower in the AFI<5 cm group compared to AFI≥5 cm (6.9 at 1 minute and 8.4 at 5 minutes, p<0.001). Conclusion Oligohydramnios after PPROM is associated with adverse perinatal outcomes such as lower Apgar scores and longer LOS in the NICU. No association was observed with latency period and chorioamnionitis.

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Long-Term Amnioinfusion through an Intrauterine Catheter in Preterm Premature Rupture of Membranes before 26 Weeks of Gestation: A Retrospective Multicenter Study

Fetal Diagnosis and Therapy ◽

10.1159/000517754 ◽

2021 ◽

pp. 1-6

Author(s):

Tomasz Goździewicz ◽

Magdalena Rycel-Dziatosz ◽

Klaudyna Madziar ◽

Tomasz Szczapa ◽

Witold Kędzia ◽

...

Keyword(s):

Latency Period ◽

Perinatal Outcomes ◽

Control Group ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Newborn Outcomes ◽

Management Group ◽

Retrospective Multicenter Study

Introduction: The objective of this study was to elucidate the efficacy of long-term amnioinfusion on perinatal outcomes in patients with preterm premature rupture of membranes (PPROM) before 26 weeks’ gestation. Material: A total of 31 patients with PPROM at a periviable gestational age (21 + 0–25 + 0 weeks) were enrolled. Long-term amnioinfusion was performed in 22 patients, and 9 patients did not receive amnioinfusion. Data were collected retrospectively from 2 clinical sites between January 2017 and March 2019. Results: In the medical management group, there was a significantly higher rate of chorioamnionitis compared to the long-term amnioinfusion group (89 vs. 15%, p = 0.001). The latency period between PPROM and delivery was higher in the amnioinfusion group (median, 5.5 vs. 3 weeks, p = 0.04). The frequency of bronchopulmonary dysplasia was higher in the control group compared to the amnioinfusion group (89 vs. 40%, p = 0.03). The rates of other neonatal complications were similar in both groups. Conclusions: Long-term amnioinfusion through an intrauterine catheter in PPROM before 26 weeks’ gestation may improve pregnancy and newborn outcomes.

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Association between latency period and perinatal outcomes after preterm premature rupture of membranes at 32–37 weeks of gestation: a perinatal registry-based cohort study

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0082 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Marie Bitenc ◽

Lea Ovsenik ◽

Miha Lučovnik ◽

Ivan Verdenik ◽

Lilijana Kornhauser Cerar

Keyword(s):

Cohort Study ◽

Cesarean Section ◽

Latency Period ◽

Perinatal Outcomes ◽

Maternal Body Mass Index ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Antenatal Corticosteroids ◽

Preterm Premature Rupture ◽

Group B

Abstract Objectives To investigate association between latency after preterm premature rupture of membranes (PPROM) and perinatal outcomes at moderately and late preterm gestation. Methods National perinatal registry-based cohort study using data for the period 2013–2018. Singleton pregnancies with non-malformed fetuses in cephalic presentation complicated by PPROM at 32+0–36+6 weeks were included. Associations between latency period and perinatal mortality, neonatal respiratory distress syndrome (RDS), early onset neonatal infection (EONI), and cesarean section were assessed using multiple logistic regression, adjusting for potential confounders (labor induction, maternal body-mass-index, maternal age, antenatal corticosteroids, and small-for-gestational-age). p<0.05 was considered statistically significant. Results Of 3,017 pregnancies included, 365 (12.1%) had PPROM at 32+0–33+6 weeks and 2,652 (87.9%) at 34+0–36+6 weeks. Among all cases, 2,540 (84%) had latency <24 h (group A), 305 (10%) 24–47 h (group B), and 172 (6%) ≥48 h (group C). Longer latency was associated with higher incidence of EONI (adjusted odds ratio [aOR] 1.350; 95% confidence interval [CI] 0.900–2.026 for group B and aOR 2.500; 95% CI 1.599–3.911 for group C) and higher rate of caesarean section (aOR 2.465; 95% CI 1.763–3.447 for group B and aOR 1.854; 95% CI 1.172–2.932 for group C). Longer latency was not associated with rates of RDS (aOR 1.160; 95% CI 0.670–2.007 for group B and aOR 0.917; 95% CI 0.428–1.966 for group C). Conclusions In moderately to late PPROM, increased latency is associated with higher risk of EONI and cesarean section with no reduction in RDS.

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Predictors of Short Latency Period Exceeding 48 h after Preterm Premature Rupture of Membranes

Journal of Clinical Medicine ◽

10.3390/jcm10010150 ◽

2021 ◽

Vol 10 (1) ◽

pp. 150

Author(s):

Marion Rouzaire ◽

Marion Corvaisier ◽

Virginie Roumeau ◽

Aurélien Mulliez ◽

Feras Sendy ◽

...

Keyword(s):

Maternal Morbidity ◽

Latency Period ◽

Preterm Births ◽

Cervical Length ◽

Short Latency ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Management Method

Background: Preterm premature rupture of membranes (PPROM) is a complication responsible for a third of preterm births. Clinical management is initially hospital based, but homecare management is possible if patients are clinically stable 48 h after PPROM. This study set out to determine factors that are predictive of short latency (delivery ≤ 7 days) exceeding 48 h after PPROM, enabling estimation of the prevalence of maternal and neonatal complications and comparison of maternal and fetal outcomes between inpatient and outpatient management. Method: This was a monocentric retrospective study conducted between 1 January 2010 and 28 February 2017 on all patients experiencing PPROM at 24 to 34 weeks + 6 days and who gave birth after 48 h. Maternal, obstetric, fetal, and neonatal variables were included in the data collected. The primary endpoint was latency, defined as the number of days between rupture of membranes and delivery. Results: 170 consecutive patients were analyzed. Short latency could be predicted by the need for tocolysis, a cervical length less than 25 mm at admission and the existence of anamnios. Outpatient follow-up was not found to lead to increased maternal morbidity or neonatal mortality. Conclusion: Our study highlights predictive factors of short latency exceeding 48 h after PPROM. Knowledge of these factors may provide justification for outpatient monitoring of patients presenting with a long cervix, absence of need for tocolysis and persistence of amniotic fluid and, thus, no risk factors after 48 h of admission.

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The Use of Somatex Shunt for Fetal Pleural Effusion: A Cohort of 8 Procedures

Fetal Diagnosis and Therapy ◽

10.1159/000515849 ◽

2021 ◽

pp. 1-8

Author(s):

Man Yan Chung ◽

Wing Cheong Leung ◽

Wing Ting Tse ◽

Yuen Ha Ting ◽

Kwok Ming Law ◽

...

Keyword(s):

Pleural Effusion ◽

Gestational Age ◽

Single Case ◽

Perinatal Outcomes ◽

In Utero ◽

Good Survival ◽

Pleural Effusions ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Live Births

Introduction: Fetal pleural effusion may require in utero shunting which is associated with procedure-related complications. Objective: To evaluate the efficacy and complications of the newly designed Somatex shunt in treating fetal pleural effusion. Methods: Consecutive cases with primary fetal pleural effusion who were treated with the Somatex shunt between 2018 and 2019 were evaluated. Perinatal outcomes and complications were retrospectively analyzed. Results: There were 6 cases of unilateral and 1 case of bilateral pleural effusion, and hence a total of 8 pleuroamniotic shunting procedures were performed. The median gestational age at diagnosis and shunting was 20.7 and 22.6 weeks, respectively. All 8 procedures were successful, achieving complete in utero drainage. All but one were live births (85.7%) with a median gestational age of 38 weeks. The single case of in utero death occurred 4.7 weeks after successful shunting, and no cause could be identified after autopsy. The rates of preterm birth and premature rupture of membranes were 33.3% (2/6) and 16.7% (1/6), respectively. Four of the 8 procedures (50%) had minor shunt-related complications such as dislodgement and entrapment, occurring at a median of 7.7 weeks after shunting. None of the shunts became blocked. Conclusions: The Somatex shunt is effective in relieving fetal pleural effusions with good survival rate. Overall, it was a safe instrument, though minor shunt complications occurred.

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