Preterm premature rupture of the membranes before viability

Décrire le taux de survie après rupture prématurée des membranes (RPM) avant 25 SA et comparer la morbi-mortalité néonatale parmi les enfants nés vivants avec des enfants nés au même terme sans RPM.

Étude rétrospective, unicentrique, menée à la maternité Port Royal entre 2007 et 2015, comparant les issues néonatales des enfants nés vivants après une RPM survenue avant 25 SA avec un groupe non exposé à la RPM. Chaque enfant né vivant après RPM était apparié avec l’enfant suivant né après travail spontané à membranes intactes sur l’âge gestationnel à la naissance, le sexe et l’administration ou non d’une corticothérapie anténatale. Un critère composite de morbidité néonatale sévère a été défini par la présence d’une ou plusieurs des complications suivantes : rétinopathie stade 3–4, dysplasie bronchopulmonaire, hémorragie intraventriculaire grade 3–4, leucomalacie périventriculaire ou décès.

Sur 77 cas de rupture très prématurée des membranes, 55 enfants sont nés vivants. Parmi les enfants nés vivants, le terme moyen de naissance était de 28 SA et 1 jour. Le taux de morbidité néonatale sévère ne différait pas entre les deux groupes (43,6 % dans le groupe RPM vs. 36,4 %, p = 0,44) et le taux de survie à la sortie de réanimation était également similaire dans les deux groupes (85,5 % vs. 83,6 %, p = 0,98).

Parmi les enfants nés vivants, la RPM avant 25 SA n’est pas associée à une augmentation du risque de morbi-mortalité par rapport à des enfants nés au même terme après travail spontané à membranes intactes.

To describe survival rate after preterm premature rupture of membranes (PPROM) before 25 weeks of gestation and compare neonatal morbidity and mortality among those born alive with a control group of infants born at a similar gestational age without premature rupture of membranes.

We conducted a retrospective single-centre study at Port-Royal maternity, from 2007 to 2015, comparing neonatal outcomes between liveborninfants exposed to PPROM prior to 25 weeks of gestation (WG) and a control group not exposed to premature rupture of the membranes. For each live-born child, the next child born after spontaneous labor without PPROM was matched for gestational age at birth, sex, and whether or not they received antenatal corticosteroid therapy. The primary endpoint was severe neonatal complications assessed by a composite endpoint including neonatal deaths, grade 3–4 HIV, bronchopulmonary dysplasia, leukomalacia and stade 3–4 retinopathies.

Among 77 cases of very premature rupture of the membranes, 55 children were born alive. Among these, the average gestational age at birth was 28 WG and 1 day. The rate of severe neonatal complications did not differ between the two groups (43.6% in the PPROM group vs. 36.4%, P = 0.44) and the survival rate at discharge was also similar in the two groups (85.5% vs. 83.6%, P = 0.98).

In our cohort and among livebirths after 24 WG, PPROM before 25 WG was not associated with an increased risk of morbidity and mortality compared to children born at the same gestational age after a spontaneous labor with intact membranes.

The purpose of this study is to investigate the factors associated with successful amniopatch treatment in patients with iatrogenic preterm premature rupture of membranes (iPPROM) or spontaneous PPROM (sPPROM) before 23 weeks' gestation.

This cohort study included 28 women who received amniopatch treatment due to iPPROM or sPPROM at 15–23 weeks' gestation. Patients' clinical characteristics before performing the amniopatch, factors associated with the procedure, pregnancy and neonatal outcomes were compared between the iPPROM and sPPROM groups, and also between the successful and failed groups.

The amniopatch was successful in 6 of 28 patients (21.4%) with a success rate of 36.4% (4/11) and 11.8% (2/17) in the iPPROM group and sPPROM group (P = 0.174), respectively. The success group had a longer PPROM-to-delivery interval, fewer cases of clinical chorioamnionitis, larger birth weight, and lower neonatal intensive care unit admission rate than the failed group. The success rate of amniopatch procedure was proportional to maximal vertical pocket prior to procedure, which showed statistically significant association (adjusted odds ratio: 3.62, 95% confidence interval: 1.16–11.31, P = 0.027).

The amniopatch treatment success rate was higher in the iPPROM group than the sPPROM group, but was not statistically significant. The neonatal outcome was more favorable when the amniopatch was successful. However, the only predictive factor associated with successful amniopatch was a larger amniotic fluid volume before the procedure.

To examine the contemporary outcome in women with rupture of membranes (PPROM) before 24 + 0 weeks’ gestation.

Retrospective analysis of women with spontaneous PPROM before 24 + 0 weeks that were treated at the University of Tuebingen/Germany. The search of the database included common maternal and pregnancy characteristics as well as the neonatal outcomes.

One hundred and one pregnancies fulfilled the inclusion criteria. 32 (31.7%) women opted for termination of pregnancy, which were excluded from further analysis. The gestational age at PPROM in the 69 women with an expectant management was 21.3 (IQR 19.1–22.6) weeks. 40 (58.0%) pregnancies carried on beyond 24 + 0 weeks. Multiple regression analysis indicated that the time of PPROM and the absence of oligo-/anhydramnios were associated with a prolongation beyond 24 + 0 weeks.

In the 40 pregnancies that remained intact beyond 24 + 0 weeks’ gestation, the fetuses were born at 27.7 (IQR 25.3–30.9) weeks. Survival without major complications was observed in 22 (55.0%) fetuses. Multiple regression analysis indicated that only the gestational age at the time of delivery was significantly associated with such an intact survival.

In cases with PPROM there is a 60% chance of a prolongation beyond 24 + 0 weeks. About half of these fetuses will be discharged alive without major complications.

To assess the impact of extreme preterm premature rupture of membranes (PPROM) <25 weeks of gestation on preterm child outcome.

Retrospective study comparing the neonatal and 2-year outcomes of infants exposed to extremely PPROM <25 weeks with a non-exposed group of neonates in a tertiary care referral centre located in Paris, France, between 2003 and 2007. All women with singleton pregnancy and PPROM between 15^0/7 and 24^6/7 weeks of gestation were recruited. For each infant born alive, the next inborn neonate matched for gestational age and sex was selected as a control among neonates born alive after spontaneous preterm labour with intact membranes. The main outcome measures were neonatal outcome assessed by a combined criterion of adverse neonatal outcomes and the two-year neurodevelopmental outcome assessed by developmental Brunet–Lézine tests and neurological examinations.

In 78 cases of extremely PPROM, 22 live births occurred at a mean gestational age of 26^5/7 weeks. The percentage of neonates with adverse neonatal outcomes was significantly higher among PPROM than non-exposed cases (68.2 versus 27.3%). At 2 years of age, children from the PPROM group were more likely to have delayed acquisitions (64.3 versus 15.8%) and behavioural disorders (57.1 versus 15.8%). Mean Brunet–Lézine language score was significantly lower among those infants (78.9 versus 96.8).

PPROM <25 weeks is associated with increased neonatal mortality and morbidity and with increased risks of delayed acquisitions, behavioural disorders and lower language performance scores at 2 years in comparison with matched preterm neonates born after spontaneous preterm labour with intact membranes.

To evaluate pregnancy outcome and the role of the amount of amniotic fluid (AF) in the prognosis of extremely preterm (<24 weeks) premature rupture of membranes (EPPROM).

Women with EPPROM and on-going pregnancy after 1 week of expectant management were included. Exclusion criteria: fetal anomalies, termination of pregnancy and spontaneous recovery of AF within the first week. The effect of the large vertical pocket (LVP) on pregnancy outcome was assessed by a Cox regression model which included three covariates: LVP measurements from rupture to 24 weeks, gestational age at rupture of membranes and sealing procedure.

Thirty-seven women were included in the study. The overall survival rate after the neonatal period was 40.5% (15/37) which increased to 62.5% (15/24) in neonates born alive after 24 weeks of gestation. Mean and S.D. of gestational age at rupture of membranes were 19.0 (±3.8) weeks. From rupture to 24 weeks, the pooled mean and standard deviation of LVP were 20.5 (±15.4) mm.

Multivariate analysis showed that the likelihood for neonate survival increased by 2.7 (95% CI 1.45–4.65) for each 5 mm of LVP during the follow-up from rupture to 24 weeks. After controlling for AF amount, neither the gestational age at rupture nor the sealing procedure showed any significant effect on pregnancy outcome.

Although the prognosis of EPPROM is poor overall, survival improves as the amount of AF before 24 weeks increases.

This study was undertaken to assess contemporary outcomes in pregnancies managed expectantly after extremely preterm premature (≤24 weeks) premature rupture of the membranes (EPPROM).

We queried antepartum and ultrasound databases for patients with EPPROM. Data on pregnancy outcome and short-term neonatal outcomes were collected.

Forty-six patients with EPPROM were studied. Patients were hospitalized at 24 weeks' gestation and given antibiotics and antenatal steroids. Median gestational age at PPROM was 22.0 weeks (range 16.9-24 weeks); 43 (93%) elected expectant management, 2 of whom later had an intrauterine fetal death. Median latency period to delivery was 13 days (range 0-96 days), with mean gestational age at delivery of 25.8±3.4 weeks. Overall survival was 47% (27 of 57 infants), after a median hospital stay of 71 days (range 17-209 days). Ten (37%) of the survivors have serious sequelae.

Although significant pregnancy prolongation after previable PPROM occurs in many cases, neonatal outcomes remain poor.