Conservative management of preterm premature rupture of membranes between 18 and 23 weeks of gestation-Maternal and neonatal outcome

Objective: To evaluate the maternal and neonatal outcome of pregnancies after preterm premature rupture of membranes (PPROM) between 18 and 23 weeks of gestation. Study design: We performed a retrospective analysis of all deliveries at the University of Miami/Jackson Memorial Hospital after PPROM between 18 and 23 weeks of gestation from January 1997 to December 1999. All patients who delivered within 12 h of rupture of membranes were excluded. We further analyzed the data by dividing the patients into three groups based on the gestational age at which PPROM occurred as follows: (1) 18-19 weeks, (2) 20-21 weeks and (3) 22-23 weeks. For statistical analysis we combined two groups 18-19 weeks and 20-21 weeks. Results: A total of 66 singleton pregnancies were included in our study. Median overall latency period until delivery was 62 h (range 12-654) with significantly prolonged latency at 22-23 weeks gestation in comparison to earlier gestation. Maternal complications were chorioamnionitis (n = 19), placental abruption (n = 3), retained placenta (n = 6) and postpartum hemorrhage (n = 5). Twenty fetuses were born alive (none between 18 and 19 weeks, 2 between 20 and 21 weeks and 18 between 22 and 23 weeks). These infants remained in the nursery between 1 and 555 days (median 106 days). A total of 12 infants were discharged home alive (1 between 20 and 21 weeks, 11 between 22 and 23 weeks). All surviving infants suffered at least one major neonatal complication. Conclusion: Conservative management of PPROM prior to 21 weeks of gestation was associated with very poor pregnancy outcome in our study. Although survival improved significantly after 22 weeks, all infants suffered major neonatal morbidity.