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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study

Authors: Laura Aoife Linehan, Jennifer Walsh, Aoife Morris, Louise Kenny, Keelin O’Donoghue, Eugene Dempsey, Noirin Russell

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

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Abstract

Background

Preterm premature rupture of membranes (PPROM) complicates 1 % of all pregnancies and occurs in one third of all preterm deliveries. Midtrimester PPROM is often followed by spontaneous miscarriage and elective termination of ongoing pregnancies is offered in many countries. The aim of this retrospective descriptive cohort study was to investigate the natural history of midtrimester PPROM in a jurisdiction where termination of pregnancy in the absence of maternal compromise is unavailable.

Methods

Cases of midtrimester PPROM diagnosed between 14 and 23 + 6 weeks’ gestation during April 2007 to June 2012 were identified following a manual search of all birth registers, pregnancy loss registers, annual reports, ultrasound reports, emergency room registers and neonatal death certificates at Cork University Maternity Hospital - a large (circa 8500 births per annum) tertiary referral maternity hospital in southwest Ireland. Cases where delivery occurred within 24 h of PPROM were excluded.

Results

The prevalence of midtrimester PPROM was 0.1 % (42 cases/44,667 births). The mean gestation at PPROM was 18 weeks. The mean gestation at delivery was 20 + 5 weeks, with an average latency period of 13 days.
Ten infants were born alive (23 %; 10/42). The remainder (77 %; 32/42) died in utero or intrapartum. Nine infants were resuscitated. Two infants survived to discharge. The overall mortality rate was 95 % (40/42).
Five women had clinical chorioamnionitis (12 %; 5/42) but 69 % demonstrated histological chorioamnionitis. One woman developed sepsis (2.4 %; 1/42). Other maternal complications included requirement of intravenous antibiotic treatment (38 %; 17/42), retained placenta (21 %, 9/42) and post-partum haemorrhage (12 %; 5/42).

Conclusions

This study provides useful and contemporary data on midtrimester PPROM. Whilst fetal and neonatal mortality is high, long-term survival is not impossible. The increased risk of maternal morbidity necessitates close surveillance.
Appendix
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Literature
1.
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(1):183–7.CrossRefPubMed
2.
Nourse CB, Steer PA. Perinatal outcome following conservative management of midtrimester pre-labour rupture of the membranes. J Paediatr Child Health. 1997;33(2):125–30.CrossRefPubMed
3.
Loeb LJ, Gaither K, Woo KS, Mason TC. Outcomes in gestations between 20 and 25 weeks with preterm premature rupture of membranes. South Med J. 2006;99(7):709–12.CrossRefPubMed
4.
Pristauz G, Bauer M, Maurer-Fellbaum U, Rotky-Fast C, Bader AA, Haas J, et al. Neonatal outcome and two-year follow-up after expectant management of second trimester rupture of membranes. Int J Gynecol Obstet. 2008;101(3):264–8.CrossRef
5.
Farooqi A, Holmgren PA, Engberg S, Serenius F. Survial and 2 year outcome with expectant management of second-trimester rupture of membranes. Obstet Gynecol. 1998;92(6):895–901.PubMed
6.
Salihu HM, Salinas-Miranda AA, Hill L, Chandler K. Survival of pre-viable preterm infants in the United States: a systematic review and meta-analysis. Semin Perinatol. 2013;37(6):389–400.CrossRefPubMed
7.
The Protections of Life During Pregnancy Act 2013, Chapter 1, section 7(1)(a)(i)
8.
9.
Gopalani S, Krohn M, Meyn L, Hitti J, Crombleholme WR. Contemporary Management of Preterm Premature Rupture of Membranes: Determinants of Latency and Neonatal Outcome. Am J Perinatol. 2004;21(4):183–90.CrossRefPubMed
10.
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(1):7–11.CrossRefPubMed
11.
Manuck TA, Eller AG, Esplin MS, Stoddard GJ, Varner MW, Silver RM. Outcomes of expectantly managed preterm premature rupture of membranes occurring before 24 weeks of gestation. Obstet Gynecol. 2009;114(1):29–37.CrossRefPubMed
12.
Holmgren PA, Olofsson JI. Preterm premature rupture of membranes and the associated risk for placental abruption. Inverse correlation to gestational length. Acta Obstet Gynecol Scand. 1997;76(8):743–7.CrossRefPubMed
13.
Verma U, Goharkhay N, Beydoun S. Conservative management of preterm premature rupture of membranes between 18 and 23 weeks of gestation--Maternal and neonatal outcome. Eur J Obstet Gynecol Reprod Biol. 2006;128(1–2):119–24.CrossRefPubMed
14.
Xiao ZH, André P, Lacaze-Masmonteil T, Audibert F, Zupan V, Dehan M. Outcome of premature infants delivered after prolonged premature rupture of membranes before 25 weeks of gestation. Eur J Obstet Gynecol Reprod Biol. 2000;90(1):67–71.CrossRefPubMed
15.
Margato MF, Martins GL, Passini Júnior R, Nomura ML. Previable preterm rupture of membranes: gestational and neonatal outcomes. Arch Gynecol Obstet. 2012;285(6):1529–34.CrossRefPubMed
16.
Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and Directorate of Strategy and Clinical Care, Health Service Executive Clinical Practice Guideline Preterm Prelabour Rupture of the Membranes Version 1.0 Date of publication: April 2013 Guideline No. 24
17.
Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and Directorate of Strategy and Clinical Care, Health Service Executive Clinical Practice Guideline The Irish Maternity Early Warning System (IMEWS) Version 1.0 Date of publication: July2014 Guideline No. 25
18.
Hofmeyr GJ, Eke AC, Lawrie TA. Amnioinfusion for third trimester preterm premature rupture of membranes. Cochrane Database Syst Rev. 2014;3:CD000942. doi:10.​1002/​14651858.
Metadata
Title
Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study
Authors
Laura Aoife Linehan
Jennifer Walsh
Aoife Morris
Louise Kenny
Keelin O’Donoghue
Eugene Dempsey
Noirin Russell
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-0813-3

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