1
|
Sorrenti S, Di Mascio D, Khalil A, D'Antonio F, Rizzo G, Zullo F, D'Alberti E, D'Ambrosio V, Mappa I, Muzii L, Giancotti A. Outcome of prelabor rupture of membranes before or at the limit of viability: systematic review and meta-analysis. Am J Obstet Gynecol MFM 2024; 6:101370. [PMID: 38648897 DOI: 10.1016/j.ajogmf.2024.101370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/21/2024] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Counseling of pregnancies complicated by pre- and periviable premature rupture of membranes to reach shared decision-making is challenging, and the current limited evidence hampers the robustness of the information provided. This study aimed to elucidate the rate of obstetrical and neonatal outcomes after expectant management for premature rupture of membranes occurring before or at the limit of viability. DATA SOURCES Medline, Embase, CINAHL, and Web of Science databases were searched electronically up to September 2023. STUDY ELIGIBILITY CRITERIA Our study included both prospective and retrospective studies of singleton pregnancies with premature rupture of membranes before and at the limit of viability (ie, occurring between 14 0/7 and 24 6/7 weeks of gestation). METHODS Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. Moreover, our study used meta-analyses of proportions to combine data and reported pooled proportions. Given the clinical heterogeneity, a random-effects model was used to compute the pooled data analyses. This study was registered with the International Prospective Register of Systematic Reviews database (registration number: CRD42022368029). RESULTS The pooled proportion of termination of pregnancy was 32.3%. After the exclusion of cases of termination of pregnancy, the rate of spontaneous miscarriage or fetal demise was 20.1%, whereas the rate of live birth was 65.9%. The mean gestational age at delivery among the live-born cases was 27.3 weeks, and the mean latency between premature rupture of membranes and delivery was 39.4 days. The pooled proportion of cesarean deliveries was 47.9% of the live-born cases. Oligohydramnios occurred in 47.1% of cases. Chorioamnionitis occurred in 33.4% of cases, endometritis in 7.0%, placental abruption in 9.2%, and postpartum hemorrhage in 5.3%. Hysterectomy was necessary in 1.2% of cases. Maternal sepsis occurred in 1.5% of cases, whereas no maternal death was reported in the included studies. When focusing on neonatal outcomes, the mean birthweight was 1022.8 g in live-born cases. The neonatal intensive care unit admission rate was 86.3%, respiratory distress syndrome was diagnosed in 66.5% of cases, pulmonary hypoplasia or dysplasia was diagnosed in 24.0% of cases, and persistent pulmonary hypertension was diagnosed in 40.9% of cases. Of the surviving neonates, the other neonatal complications included necrotizing enterocolitis in 11.1%, retinopathy of prematurity in 27.1%, and intraventricular hemorrhage in 17.5%. Neonatal sepsis occurred in 30.2% of cases, and the overall neonatal mortality was 23.9%. The long-term follow-up at 2 to 4 years was normal in 74.1% of the available cases. CONCLUSION Premature rupture of membranes before or at the limit of viability was associated with a great burden of both obstetrical and neonatal complications, with an impaired long-term follow-up at 2 to 4 years in almost 30% of cases, representing a clinical challenge for both counseling and management. Our data are useful when initially approaching such patients to offer the most comprehensive possible scenario on short- and long-term outcomes of this condition and to help parents in shared decision-making. El resumen está disponible en Español al final del artículo.
Collapse
Affiliation(s)
- Sara Sorrenti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy (Drs Sorrenti, Di Mascio, Zullo, D'Alberti, D'Ambrosio, Muzii, and Giancotti)
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy (Drs Sorrenti, Di Mascio, Zullo, D'Alberti, D'Ambrosio, Muzii, and Giancotti).
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, England, United Kingdom (Dr Khalil); Fetal Medicine Unit, St George's Hospital, London, United Kingdom (Dr Khalil)
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr D'Antonio)
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, University of Roma Tor Vergata, Rome, Italy (Drs Rizzo and Mappa)
| | - Fabrizio Zullo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy (Drs Sorrenti, Di Mascio, Zullo, D'Alberti, D'Ambrosio, Muzii, and Giancotti)
| | - Elena D'Alberti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy (Drs Sorrenti, Di Mascio, Zullo, D'Alberti, D'Ambrosio, Muzii, and Giancotti)
| | - Valentina D'Ambrosio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy (Drs Sorrenti, Di Mascio, Zullo, D'Alberti, D'Ambrosio, Muzii, and Giancotti)
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, University of Roma Tor Vergata, Rome, Italy (Drs Rizzo and Mappa)
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy (Drs Sorrenti, Di Mascio, Zullo, D'Alberti, D'Ambrosio, Muzii, and Giancotti)
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy (Drs Sorrenti, Di Mascio, Zullo, D'Alberti, D'Ambrosio, Muzii, and Giancotti)
| |
Collapse
|
2
|
Brady S, Martin M, Keerthy D, Liao G, Breslin N, Parravicini E. Respiratory outcomes of neonates born after previable premature rupture of membranes and treated with gentle ventilation. J Perinatol 2024:10.1038/s41372-024-02014-1. [PMID: 38822149 DOI: 10.1038/s41372-024-02014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE We aim to describe neonatal respiratory outcomes following previable preterm premature rupture of membranes(PPROM) when gentle ventilation is utilized. We also report maternal morbidity and mortality. STUDY DESIGN This is a retrospective single-center cohort study of infants delivered between 2016 and 2020 that included infants born at ≥23 weeks without major congenital anomaly after a pregnancy complicated with PPROM before 23 weeks gestation. Statistical analysis utilized unpaired Student's t-test or Mann-Whitney U-test when appropriate. RESULTS 35 infants from 33 pregnancies were included. 91.4% of infants survived until discharge and 12.1% developed Bronchopulmonary Dysplasia (BPD). Those who developed BPD had significantly lower amniotic fluid levels prior to delivery (p < 0.05). There was no significant maternal morbidity or mortality in this cohort. CONCLUSION This cohort had high survival and low rates of respiratory morbidities. This suggests the use of gentle ventilation might be the optimal strategy for patients born after previable PPROM.
Collapse
Affiliation(s)
- Sinead Brady
- Division of Neonatal and Perinatal Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
| | - Mary Martin
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Divya Keerthy
- Division of Neonatology, Department of Pediatrics New York Presbyterian Hospital Queens, New York, NY, USA
| | - Grace Liao
- Division of Neonatology, Department of Pediatrics, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Noelle Breslin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center, New York, NY, USA
| | - Elvira Parravicini
- Division of Neonatal and Perinatal Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| |
Collapse
|
3
|
Phillips A, Pagan M, Smith A, Whitham M, Magann EF. Management and Interventions in Previable and Periviable Preterm Premature Rupture of Membranes: A Review. Obstet Gynecol Surv 2023; 78:682-689. [PMID: 38134338 DOI: 10.1097/ogx.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Importance Periviable and previable premature rupture of membranes (pPPROM) occurs in <1% of pregnancies but can have devastating consequences for the mother and the fetus. Understanding risk factors, possible interventions, and both maternal and neonatal outcomes will improve the counseling and care provided for these patients. Objective The aim of this review is to describe the etiology, risk factors, management strategies, neonatal and maternal outcomes, and recurrence risk for patients experiencing pPPROM. Evidence Acquisition A PubMed, Web of Science, and CINAHL search was undertaken with unlimited years searched. The search terms used included "previable" OR "periviable" AND "fetal membranes" OR "premature rupture" OR "PROM" OR "PPROM." The search was limited to English language. Results There were 181 articles identified, with 41 being the basis of review. Multiple risk factors for pPPROM have been identified, but their predictive value remains low. Interventions that are typically used once the fetus reaches 23 to 24 weeks of gestation have not been shown to improve outcomes when used in the previable and periviable stage. Neonatal outcomes have improved over time, but survival without severe morbidity remains low. Later gestational age at the time of pPPROM and longer latency period have been shown to be associated with improved outcomes. Conclusions and Relevance Periviable and previable premature rupture of membranes are uncommon pregnancy events, but neonatal outcomes remain poor, and routine interventions for PPROM >24 weeks of gestation have not proven beneficial. The 2 most reliable prognostic indicators are gestational age at time of pPPROM and length of the latency period.
Collapse
Affiliation(s)
- Amy Phillips
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Megan Pagan
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Alex Smith
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Megan Whitham
- Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR; Virginia Tech Carilion School of Medicine, Roanoke, VA
| |
Collapse
|
4
|
Paulsen V, Jakob M, Gembruch U, Heep A, Bartmann P. Previable preterm premature rupture of membranes: 117 cases with neonatal outcomes in light of current research. J Neonatal Perinatal Med 2023; 16:21-31. [PMID: 36872792 DOI: 10.3233/npm-221054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND ppPROM < 24 + 0 weeks of gestation complicates < 1 % of all pregnancies but is responsible for significant maternal and neonatal morbidity. It is associated with 18-20% of perinatal deaths. OBJECTIVE To evaluate neonatal outcome after expectant management in ppPROM in order to obtain evidence-based information for purposes of future counselling. METHODS A single-centre, retrospective cohort study of 117 neonates born 1994 to 2012 after ppPROM < 24 weeks of gestation with a latency period > 24 hours and admission to the NICU of the Department of Neonatology, University of Bonn. Data of pregnancy characteristics and neonatal outcome were collected. The results were compared to those found in the literature. RESULTS The mean gestational age at ppPROM was 20.45±2,9 weeks (range 11 + 2 -22 + 6) with a mean latency period of 44.7±34.8 days (range 1-135). Mean gestational age at birth was 26.77±3.22 weeks (range 22 + 2-35 + 3). 117 newborns were admitted to the NICU, the overall survival rate at discharge was 72.6% (85/117). Non-survivors had a significantly lower gestational age and higher rates of intra-amniotic infections. The most common neonatal morbidities were RDS (76.1%), BPD (22.2%), pulmonary hypoplasia (PH) (14.5%), neonatal sepsis (37.6%), IVH (34.1% all grades, 17.9% grades III/IV), NEC (8.5%) and musculoskeletal deformities (13.7%). Mild growth restriction as a new complication of ppPROM was observed. CONCLUSIONS Neonatal morbidity after expectant management is similar to that described for infants without ppPROM, but carries a higher risk of pulmonary hypoplasia and mild growth restriction.
Collapse
Affiliation(s)
- V Paulsen
- Department of Neonatology and Paediatric Intensive Care, University of Bonn, Bonn, Germany.,University Children's Hospital of Cologne, Medical Faculty, University of Cologne, Cologne, Germany
| | - M Jakob
- Department of Otorhinolaryngology, Head and Neck Surgery, Pan Clinic Neumarkt, Cologne, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Heep
- Medical Centre Oldenburg University, Children's Hospital Oldenburg, Oldenburg, Germany
| | - P Bartmann
- Department of Neonatology and Paediatric Intensive Care, University of Bonn, Bonn, Germany
| |
Collapse
|
5
|
Terece C, Turan G, Uckan HH, Eser A, Ozler MR, Gunbay S, Taner MZ. The analysis of pregnancies terminated before and after the limit of viability: A medicolegal view. J Forensic Leg Med 2023; 95:102491. [PMID: 36758309 DOI: 10.1016/j.jflm.2023.102491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE In the present study, the purpose was to determine the indications of pregnancy termination procedures that are performed before and after the limit of viability (between 10 and 22 weeks) in a tertiary center and to investigate the characteristics of the cases in which fetocide procedure was offered after the limit of viability (22 weeks and later). It also aimed to discuss the legal deadline for the fetocide procedure and legal aspect of pregnancy termination. MATERIAL AND METHOD The present study was conducted as a result of the retrospective examination of 198 cases who underwent pregnancy termination after the 10th week of pregnancy (the legal limit for voluntary termination of pregnancy in our country) in our clinic and met the study criteria. The cases were divided into two main groups as Early Termination (10-22 weeks) and Late Termination (22 weeks and later). The characteristics of these groups (i.e. reason for termination, termination week) and the characteristics of the cases in which fetocide procedure was performed and the cases that were not (i.e. termination week, reasons for termination) were compared. RESULTS A total of 171 (86%) cases were under 22 weeks and 27 (14%) were 22 weeks or more. In the cases terminated early, the gestational week was found to be highest [20 + 1 (12+3-21 + 1)] in those with preterm premature rupture of membranes, and lowest in those with fetal gastrointestinal abnormalities. No statistically significant differences were detected between the termination reason and the gestational week in the late-terminated group, and also, although the termination week of 5 patients for whom the fetocide procedure was offered [median = 23 + 1 (22+4-26 + 0] was higher than the week of 22 patients for whom the fetocide procedure was not offered [median = 22 + 4 (22+1-25 + 4], the difference was not found to be statistically significant. CONCLUSION Since the majority of pregnancy terminations are performed before the viable period, the need for the fetocide procedure in pregnancy terminations is relatively low, and we think that this rate will decrease even more because the rate of early diagnosis of fetal anomalies increases as a result of developments in ultrasonographic imaging. Families who choose the termination of pregnancy search for other countries with appropriate legislation and the loss of time and the indecision of the family might cause the application of pregnancy termination after the viable period because of the limitations in the legal regulations of countries.
Collapse
Affiliation(s)
- Cem Terece
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Gokce Turan
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Hasan Hüseyin Uckan
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Ayla Eser
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Mustafa Rasit Ozler
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Suheda Gunbay
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Mehmet Zeki Taner
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| |
Collapse
|
6
|
Stein RA, Katz A, Chervenak FA. The far-reaching impact of abortion bans: reproductive care and beyond. EUR J CONTRACEP REPR 2023; 28:23-27. [PMID: 36369860 DOI: 10.1080/13625187.2022.2140008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
On 24 June 2022, the US Supreme Court overturned Roe v. Wade, a 49-year-old precedent that provided federal constitutional protection for abortions up to the point of foetal viability, returning jurisdiction to the individual states. Restrictions that came into effect automatically in several states, and are anticipated in others, will severely limit access to abortions in approximately half of the US. Even though every state allows for exceptions to the abortion bans, in some instances these exceptions can be used to preserve the health of a pregnant patient, while in other instances, only to preserve their life. The vague and confusing nature of the abortion ban exceptions threatens to compromise the standard of care for patients with pregnancy complications that are distinct from abortions, such as nonviable pregnancies, miscarriages, and ectopic pregnancies. Additionally, we envision challenges for the treatment of women with certain autoimmune conditions, pregnant cancer patients, and patients contemplating preimplantation genetic diagnosis as part of assisted reproductive technologies. The abortion ban exceptions will impact and interfere with the medical care of pregnant and non-pregnant patient populations alike and are poised to create a medical and public health crisis unlike any other one from the recent past.
Collapse
Affiliation(s)
- Richard A Stein
- Department of Chemical and Biomolecular Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - Adi Katz
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA
| | - Frank A Chervenak
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA
| |
Collapse
|
7
|
Feduniw S, Gaca Z, Malinowska O, Brunets W, Zgliczyńska M, Włodarczyk M, Wójcikiewicz A, Ciebiera M. The Management of Pregnancy Complicated with the Previable Preterm and Preterm Premature Rupture of the Membranes: What about a Limit of Neonatal Viability?—A Review. Diagnostics (Basel) 2022; 12:diagnostics12082025. [PMID: 36010375 PMCID: PMC9407094 DOI: 10.3390/diagnostics12082025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Preterm premature rupture of the membranes (PPROM) at the limit of viability is associated with low neonatal survival rates and a high rate of neonatal complications in survivors. It carries a major risk of maternal morbidity and mortality. The limit of viability can be defined as the earliest stage of fetal maturity when a fetus has a reasonable chance, although not a high likelihood, for extra-uterine survival. The study reviews available data on preventing preterm delivery caused by the previable PPROM, pregnancy latency, therapeutic options including the use of antibiotics and steroids, neonatal outcomes, and future directions and opportunities.
Collapse
Affiliation(s)
- Stepan Feduniw
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland
- Correspondence:
| | | | - Olga Malinowska
- Faculty of Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland
| | | | - Magdalena Zgliczyńska
- Department of Obstetrics, Perinatology and Neonatology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Marta Włodarczyk
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland
- Centre for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Anna Wójcikiewicz
- Second Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland
| |
Collapse
|
8
|
Herzlich J, Mangel L, Halperin A, Lubin D, Marom R. Neonatal outcomes in women with preterm premature rupture of membranes at periviable gestational age. Sci Rep 2022; 12:11999. [PMID: 35835823 PMCID: PMC9283543 DOI: 10.1038/s41598-022-16265-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/07/2022] [Indexed: 11/09/2022] Open
Abstract
To examine the outcomes of preterm infants born to women with preterm premature rupture of membranes (PPROM) at periviable gestational age. This is an observational retrospective cohort study analyzing data collected on singleton deliveries complicated by prolonged premature rupture of membranes occurring between 17 and 33 weeks of gestation. Neonatal outcomes including birth weight, Apgar score, retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, hearing impairment and mortality were evaluated. Ninety-four preterm infants who were born after a prolonged premature rupture of membranes of at least 7 days were included in the study. Median gestational week at onset of membrane rupture was 27.1 ± 4.2 weeks (range 17–33) and median latency period in days was 16 ± 21.8 (range 7–105). The cohort was stratified by gestational week (GW) at onset of PPROM (group 1: 17–23, group 2: 24–27, and group 3: 28–33). We found that the survival rate to discharge within neonates born after prolonged rupture of membrane at gestational week less than 24 weeks is 79.2% and 88.9% in group 2. These neonates did not show an increased rate of major morbidities compared to neonates born following membrane rupture at gestational week 24 to 27. We described a high survival rate to discharge without major morbidities following prolonged preterm membrane rupture of at least 7 days of latency before viability.
Collapse
Affiliation(s)
- Jacky Herzlich
- Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laurence Mangel
- Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Halperin
- Department of Obstetrics, Gynecology, Mayanei HaYeshua Center, Bnei Brak, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lubin
- Department of Neonatology, Mayanei HaYeshua Center, Bnei Brak, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronella Marom
- Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel.
| |
Collapse
|
9
|
Can E, Oğlak SC, Ölmez F. Maternal and neonatal outcomes of expectantly managed pregnancies with previable preterm premature rupture of membranes. J Obstet Gynaecol Res 2022; 48:1740-1749. [PMID: 35411577 DOI: 10.1111/jog.15239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/06/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to describe the maternal and fetal outcomes associated with expectant management following previable preterm premature rupture of membranes (PPROM) before 24 weeks of gestation. We also analyzed the risk estimates of potential confounders to clarify whether these variables are contributed to the risk of postnatal mortality among these neonates. METHODS This retrospective cohort study included all pregnant patients who experienced previable PPROM before 24 weeks of gestation at a tertiary maternal-fetal medicine center. We used the neonatal data from birth until discharge. RESULTS A total of 128 women were enrolled. The survival to discharge rate was 60.9%. The median latency period (80 vs. 20 days, respectively, p < 0.001) was significantly longer, the median gestational week at delivery (34 vs. 25 weeks, respectively, p < 0.001) and median birth weight (2100 vs. 710 g, p < 0.001) was significantly higher in the survivor group than the non-survivor group. Surviving neonates had significantly lower frequencies of anhydramnios at any time during the latency period than the non-survivor neonates (38.4% vs. 86.0%, respectively, p < 0.001). CONCLUSION This study demonstrated an opposite correlation between the duration of latency period and gestational age at PPROM with earlier membrane rupture in pregnancies having a longer latency period, which additionally clarifies the higher gestational age at delivery. The antepartum factors that increased the possibility of postnatal mortality within our study included the gestational week at delivery, duration of the latency period, anhydramnios at any time during the latency period, and birth weight.
Collapse
Affiliation(s)
- Esra Can
- Department of Obstetrics and Gynecology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Cemil Oğlak
- Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Fatma Ölmez
- Department of Obstetrics and Gynecology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|