Neonatal Outcome Still Poor After Very Early Membrane Rupture

NEW YORK (Reuters Health) Feb 18 - Pregnancies managed expectantly following premature rupture of the membranes at 24 weeks or less can often be prolonged, but neonatal outcome remains poor, according to Illinois-based researchers.Dr. Mara J. Dinsmoor and colleagues at Evanston Northwestern Healthcare, Illinois note in the January issue of the American Journal of Obstetrics and Gynecology that preterm premature rupture of the membranes (PPROM) occurs in as many as 4.5% of pregnancies. However, less than 1% occur before viability.To establish neonatal short-term outcome following such particularly early PPROM, the researchers queried databases and identified 46 patients. All were hospitalized at 24 weeks and given antibiotics and antenatal steroids.The mean gestational age at PPROM was 22 weeks, the median latency period to delivery was 13 days, although this ranged from no delay to 96 days, and the mean gestational age at delivery was 25.8 weeks. Overall, 27 of 57 infants (47%) survived after a median hospital stay of 71 days. Most deaths (63%) were ascribed to extreme prematurity. Ten of the survivors (37%) had serious sequelae such as bronchopulmonary dysplasia. The researchers observe that the routine use of antibiotics and steroids appears to have led to an improvement in survival after early PPROM. Nevertheless, they conclude, "morbidity remains high."

Am J Obstet Gynecol 2004;190:183-187.

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