Outcomes following prolonged pre-term premature rupture of the membranes

Abstract

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

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

Results: Of ninety-eight 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 (78%), the survival rate to hospital discharge was 70%. Airleak occurred in 7 (25%) survivors and 8 (67%) deaths. Amongst survivors, 12 (43%) required supplemental oxygen at 36 weeks post menstrual age and no infant had grades 3 or 4 intraventricular haemorrhage. One infant had a post mortem diagnosis of pulmonary hypoplasia and nine others had clinical features consistent with the 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 our cohort delivered following membrane rupture occurring before 24 weeks’ gestation, of at least 14 days duration, is better than previously reported.