4 - Comparison of Maternal and Neonatal Outcomes for Periviable PPROM < 20 Weeks versus 20-24 Weeks Gestation: A Systematic Review and Meta-analysis

Poster Number: 4
Publication Number: 4.337

Maura Helena Ferrari Resende, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Vibhuti S. Shah, Mount Sinai Hospital, MIssissauga, ON, Canada; Bonny Jasani, The Hospital for Sick Children, Toronto, ON, Canada

Background: Periviable preterm premature rupture of membranes (pPPROM) prior to 24 weeks gestation’, although rare (~ 3.7 in 1000 pregnancies), is associated with potentially devastating maternal, fetal and neonatal complications. There is limited contemporary data comparing the outcomes after early maternal pPPROM < 20 weeks gestational age [GA]) versus late pPPROM between 20- 24 weeks GA that might influence counselling families and guide clinical decision making.

Objective: To conduct a systematic review and meta-analysis comparing maternal, fetal and neonatal morbidities and mortality following maternal pPPROM < 20 weeks versus 20- 24 weeks GA.

Design/Methods: MEDLINE, EMBASE and COCHRANE databases were searched from January 2000 to December 2021 to identify eligible studies comparing maternal, fetal and neonatal outcomes in pregnant individuals with pPPROM < 20 weeks versus 20 - 24 weeks GA. The primary outcome was the rate of in-hospital mortality amongst live born infants. Key secondary outcomes included fetal demise, preterm labour, histological chorioamnionitis, pulmonary hypoplasia, skeletal deformities, and intraventricular hemorrhage (IVH) > grade III.  Risk of bias was assessed with Iorio tool which focuses on studies reporting incidence of outcomes. Meta-analysis was performed using random effects model and the certainty of evidence was rated according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE).

Results: Eighteen observational studies of 1649 live infants were included. There was no statistically significant difference between the two groups for in-hospital mortality amongst live born infants [Relative risk (RR) 1.30, 95% confidence interval (CI) 0.94 to 1.80; I2 = 82%; p 0.11; 18 studies, N = 1649; GRADE: Low]. Compared to 20 - 24 weeks GA, the incidence of fetal demise, pulmonary hypoplasia and skeletal deformities was significantly higher after maternal pPPROM < 20 weeks GA. All primary and secondary outcomes are presented in Tables 1 and 2. The certainty of evidence was low to very low for all pre-specified secondary outcomes. Conclusion(s): Although no difference for in-hospital mortality is noted between the two groups, pPPROM < 20 weeks GA is associated with significantly higher rate of fetal demise, pulmonary hypoplasia and neonatal skeletal deformities. Our findings may guide counselling, fetal monitoring and clinical management of pregnancies with pPPROM < 24 weeks GA.
Table 1: Maternal Outcomes
Table 2: Neonatal Outcomes1Based on live births; 2Based on all pregnancies with PPROM < 24 weeks gestation. IVH: intraventricular hemorrhage.