Abstract
Previable premature prelabor rupture of membranes (pPPROM) can lead to significant
maternal and neonatal morbidity and mortality. Limited literature exists describing
long-term outcomes in neonates surviving pPPROM. Our study describes 2-year survival
and outcomes after expectantly managed pPPROM at a single, tertiary, academic center.
This is a retrospective review including individuals with pPPROM defined as membrane
rupture before 240/7 weeks who were candidates and opted for expectant management at a single tertiary
academic center between 2013 and 2022. Patients were included if they delivered after
22 weeks. Patients opting for termination, with contraindication to expectant management
or who chose expectant management without planned neonatal resuscitation at birth
were excluded. Electronic records of patients and associated neonates were reviewed
for demographic information, PPROM management, and neonatal outcomes at 2 years including
gastrointestinal, respiratory, cognitive, motor, and hearing or vision issues. Descriptive
statistical analysis was performed. Of 111 pregnancies with pPPROM, 50(45%) pregnant
individuals met inclusion criteria (46 singletons; 4 multiples [3 twins, 1 set of
quads]). Of 46 singletons, 31 (67%) survived to 2 years with 1(3%) alive but less
than 2 years. In 3/4 (75%) twin gestations, both twins survived to 2 years. A total
of 3/4 (75%) quadruplets survived to 2 years. Most surviving infants (95.0%, n = 38) had at least one documented adverse outcome. A total of 55.0% (n = 22) of neonates had gross motor delay, and 77.5% (n = 31) had documented speech delay. Most had respiratory issues with reactive airway
disease most common (22.5% n = 9). Gastrointestinal issues were common with gastrostomy tube in 32.5% (n = 13) and short gut syndrome in 15% (n = 6). Over half of neonates with expectantly managed pPPROM survived with high rates
of adverse outcomes with over half with documented gross motor and speech delay present
at 2 years. Respiratory and gastrointestinal issues were also common. These data provide
information for important patient counseling on long-term outcomes in expectantly
managed pPPROM.
Key Points
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Adverse outcomes at 2 years after pPPROM were prevalent.
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Speech delay at 2 years was the most common outcome.
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Motor delay occurred in 55% of neonates at 2 years.
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Long-term pPPROM data can guide counseling.
Keywords
neonatal morbidity - neonatal mortality - periviability - previability - premature
birth - PPROMs - pPPROMs
