462 - Neonatal outcomes in women with preterm premature rupture of membranes at periviable gestational age

Poster Number: 462
Publication Number: 462.130

Jacky Herzlich, Tel Aviv medical center, Tel Aviv, Tel Aviv, Israel; Laurence Mangel, Tel Aviv Medical Center, Tel Aviv, Tel Aviv, Israel; Ariel Halperin, Tel aviv, Tel Aviv, Tel Aviv, Israel; Daniel Lubin, mh, Bne Brak, Tel Aviv, Israel; Ronella Marom, tel aviv medical center, tel aviv, Tel Aviv, Israel

Background: The incidence of PPROM, at periviable gestational age (broadly defined as 20 0/7 through 25 6/7 weeks of gestation) is less common, affecting approximately four in 1000 pregnancies.The last Cochrane on this issue recommended a policy of expectant management between 25 to 37 weeks of pregnancy with careful monitoring to achieve better outcomes for the mother and her baby.
Although these gestational age-based guidelines are essential to health care providers in the maternal/neonatal treatment decision-making, counselling parents on the rate of neonatal survival and long-term disabilities is a challenging complex issue, and present women with dilemmas in view of individual circumstances and patient values especially in cases were premature rupture of membrane happens before viability.

Objective: To examine the outcomes of preterm infants born to women with preterm premature rupture of membranes at periviable gestational age.

Design/Methods: This is a retrospective study analyzing data on singleton deliveries complicated by prolonged premature rupture of membranes (≥ 1 week) occurring before 24 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.

Results: Ninety four preterm infants who were born after a prolonged premature rupture of membranes of at least 7 days were included in the study and classified per gestational week at onset of membrane rupture, as group 1 (17 - 23 weeks), group 2 (24 - 27 weeks) and group 3 (28 - 33 weeks).The average gestational age at delivery was 30.8 ± 3.1weeks (range 23 - 34). 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). 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%. These neonates did not show an increased rate of major morbidities compared to neonates born following membrane rupture at gestational week 24 to 27.Conclusion(s): We described a high survival rate without major morbidities following prolonged preterm membrane rupture before viability.