Perinatal Outcomes of Pre-viable Preterm Premature Rupture of Membranes

Abstract

Objective: To assess the maternal and neonatal outcomes after expectant management of pre-viable preterm premature rupture of membranes (PPROM). Data Sources: We searched PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science databases for publications from 2008 to 2018 and ClinicalTrials.gov. Methods of Study Selection: All studies that reported pregnancy outcomes of pre-viable PPROM were included. Excluded were the review articles, case reports, and studies that exclusively included patients with a particular characteristic (oligohydramnios/prolonged latency), those evaluating the effect of a specific intervention, or the ones providing aggregate data from which information for patients with PPROM <24 weeks could not be delineated. Tabulation, Integration, and Results: Eighteen studies were reviewed that examined the outcomes of 1,372 pre-viable PPROM women following expectant management. Data was extracted in the form of predesigned tables. We used Microsoft Excel to integrate the results of included studies. The overall neonatal survival to discharge was 41.5%. Of these, 48.8% neonates survived without a major morbidity. Respiratory morbidity was the most common morbidity among surviving neonates: 49.5% neonates suffered from respiratory distress syndrome, 30% from bronchopulmonary dysplasia, and 10.7% from pulmonary hypoplasia. Chorioamnionitis was the most frequently observed maternal morbidity, complicating 49.3% pre-viable PPROM. The predictors for favorable outcomes included a later gestational age at PPROM and delivery, absence of oligohydramnios, and iatrogenic PPROM. Of note, 21.6% of pre-viable PPROM women opted for the termination of pregnancy. Conclusion: The neonatal survival rate of pre-viable PPROM after expectant management is 4 of 10 affected neonates, and nearly half of them survive without any major morbidity. Maternal morbidity remains substantial, however, serious maternal complications are rare.