Pregnancy and Neonatal Outcomes of Periviable Preterm Prelabor Rupture of Membranes
Ng Yang Huang Grace, Tan Yin Yee, Quek Bin Huey, Shephali Tagore, Tan Pih Lin, Ann Wright
Abstract
Background: There has been a steady improvement in the prognosis of neonates born at periviable gestations with regard to survival and neurodisability because of both technologic advances and better understanding of perinatal care. At our tertiary obstetric and neonatal care facility (KK Women’s and Children’s Hospital, Singapore), we encourage prospective parents to make informed decisions on the pregnancy course in cases of periviable preterm prelabor rupture of membranes (PPROM) after detailed medical counseling. This information may be useful to clinicians in guiding management in similar situations.
Aim: To study the pregnancy and neonatal outcomes up to 2 years in women presenting with periviable PPROM
Materials and Methods: This was a 5-year retrospective study of women presenting with PPROM at < 34 weeks of gestation, with special focus on the 21 of 134 women with PPROM between 20 0/7 to 25 6/7 weeks of gestation. The latency between rupture of membranes and delivery, mode of delivery, prenatal course, and neonatal outcomes were recorded and compared.
Results: The 21 women were divided into 3 subgroups based on the gestational age at the time of PPROM—20 0/7 to 21 6/7 weeks, 22 0/7 to 23 6/7 weeks, and 24 0/7 to 25 6/7 weeks. The median gestational age at the time of PPROM was 21, 23, and 24 6/7 weeks for the 3 groups, respectively. The median latencies were 34, 17, and 3 days; median gestational ages at delivery were 25 4/7, 25, and 25 3/7 weeks; and median neonatal birth weights were 850, 700, and 700 g, respectively. Six women had normal vaginal delivery, and 15 women had cesarean delivery. There was 1 intrauterine death and 5 neonatal deaths. The overall survival rate was 71.4%. The major morbidity among the survivors was chronic lung disease, which affected 13 of the 15 (87%) survivors.
Conclusions: Further to the available literature, the results of our study too show that PPROM at 20 0/7 to 25 6/7 weeks is associated with high rates of neonatal mortality and morbidity. The survival rate in our study was 71.4%, with no severe morbidity at 2 years of age.
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