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Outcomes following prolonged preterm premature rupture of the membranes

¹ Department of Neonatal Medicine, Royal Women’s Hospital, Melbourne, Victoria, Australia
² Department of Obstetrics and Gynaecology, Royal Women’s Hospital and University of Melbourne, Melbourne, Victoria, Australia
³ Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Australia

Correspondence to:
Dr N J Everest, Department of Neonatal Medicine, Royal Children’s Hospital, Flemington Road, Parkville, Australia 3052; neverest{at}mac.com

Objective: Rupture of the membranes in the second trimester is reported to be associated with high rates of pregnancy loss, neonatal mortality and morbidity. This article describes the outcomes of liveborn infants delivered following a prolonged period of membrane rupture occurring before 24 weeks’ gestation.

Patients and setting: Over a 5-year period, consecutive pregnancies complicated by spontaneous rupture of the membranes before 24 weeks’ gestation were identified. Evaluation of short-term outcomes before discharge of liveborn infants delivered, in a tertiary referral centre, following prolonged rupture of membranes of duration greater than 2 weeks.

Results: Of 98 pregnancies identified with rupture of the membranes before 24 weeks’ gestation, 40 (41%) women progressed to deliver a liveborn infant following a latent period of at least 14 days. Although most liveborn infants required neonatal intensive care including mechanical ventilation (n = 38; 78%), the survival rate to hospital discharge was 70% (n = 28). Airleak occurred in 7 (25%) survivors and 8 (67%) deaths. Among the survivors, 12 (43%) required supplemental oxygen at 36 weeks’ postmenstrual age and no infant had grade 3 or 4 intraventricular haemorrhage. One infant had a postmortem diagnosis of pulmonary hypoplasia and nine others had clinical features consistent with this diagnosis. Low liquor volume was not uniformly associated with a poor outcome.

Conclusion: With full contemporary neonatal intensive care, the outcome for liveborn infants in the present cohort delivered following membrane rupture occurring before 24 weeks’ gestation, of at least 14 days duration, was better than previously reported.