Perinatal outcome in pregnancies with extreme preterm premature rupture of membranes [Mid-Trimester PROM]

Preterm premature rupture of membranes [PPROM] is defined as the rupture of fetal membranes before 37 weeks. Extreme PPROM occurs before 26 weeks' gestation and can result in perinatal morbidity and mortality. The aim of this study was to study the perinatal outcomes of mothers with extreme PPROM. A retrospective cohort study of 44 consecutive pregnant women, presenting with PPROM before 26 weeks' gestation, was conducted from January 2006 to December 2011 at Sultan Qaboos University Hospital, Oman. Maternal and neonatal information was collected from medical records, and delivery and neonatal unit registries. Women with PPROM presenting after 26 weeks' gestation, those with multiple gestations, or other types of preterm deliveries were excluded from the study. Of the 44 preterm infants admitted to the Neonatal Intensive Care Unit, 24 [55%] survived, 7 [16%] died within 24 hours of birth, 9 [20%] were miscarried, and 4 [9%] were stillbirths. Neonatal sepsis and pulmonary hypoplasia were the major causes of death. Neonatal complications among the surviving infants included prematurity in 11 [46%], respiratory distress syndrome in 19 [79%], sepsis in 12 [50%], and low birth weight in 11 [46%]. The neonatal survival rate was significantly associated with the gestational age at delivery but not with the gestational age upon rupture of membranes. Extreme PPROM was associated with adverse perinatal outcomes. The results of this study will help obstetricians and neonatologists in counseling couples experiencing PPROM. Future studies of long-term neonatal morbidity should have larger sample sizes and include more hospitals

Extreme preterm premature rupture of membranes: risk factors and feto maternal outcomes

Preterm premature rupture of membranes [PPROM] is defined as a rupture of the amniotic membranes occurring before 37 weeks of gestation and before the onset of labor. Extreme PPROM occurs prior to 26 weeks gestation and contributes to an increased risk of prematurity, leading to maternal and fetal complications. This study aims to estimate the risk factors associated with various maternal complications and to determine the worst outcomes in Omani females with extreme PPROM. A retrospective cohort study was conducted on 44 women with extreme PPROM, who delivered at Sultan Qaboos University Hospital [SQUH] from January 2006 to December 2011. Women with incomplete information, multiple gestations, or a preterm delivery resulting from medical intervention, as well as women who delivered elsewhere were excluded from the study. Forty-four women with extreme PPROM were included in our study. The results revealed the most important risk factor to be history of infection, which was noted in 24 study participants. The mean maternal age was 30 years. The mean gestational age at PPROM and at delivery were 20.7 +/- 3.2 [range: 16-26 weeks] and 29.7 +/- 7.6 weeks [range: 17-40 weeks], respectively. The maternal complications observed in this study included; infection which was seen in 20 [45%] patients, antepartum hemorrhage in 11 [25%] patients, and cesarean section which was required in 12 [27%] patients. There was no significant association between risk factors such as gestational age at delivery, parity, maternal age at PPROM, or maternal Body Mass Index [BMI] and cesarean section rate. Infection played a major role, both as a risk factor and in causing extreme PPROM, which in turn increased in 12 patients [27%]. In the multivariable model for predicting the need for cesarean section [gestational age at delivery, parity, maternal age at PPROM in years and maternal BMI], none of the factors were statistically significant. Overall, concurrent infection rate was high among patients presenting with extreme PPROM. None of the baseline maternal factors predicted the need for cesarean section. This is likely due to the small sample size; hence, larger prospective studies are needed to confirm these findings