Subsequent Pregnancy after Preterm Prelabor Rupture of Membranes before 27 Weeks' Gestation

Abstract

Objective Midtrimester preterm prelabor rupture of membranes (PPROM) has a high rate of neonatal mortality and morbidity. The aim of this study was to study outcomes of subsequent pregnancies after a pregnancy with PPROM before 27 weeks' gestation.

Study Design Retrospective study of subsequent pregnancies of women who suffered PPROM before 27 weeks' gestation from 1994 to 2009. The main outcome measure was the risk of recurrence of PPROM before 27 weeks' gestation. The authors also studied preterm birth and pregnancy outcome in the subsequent pregnancy. Finally, they assessed associative factors for subsequent premature delivery.

Results They identified 307 patients, of whom 118 women had a subsequent pregnancy. Of 99 women with complete outcome data, 9 women (9%) had PPROM before 27 weeks' gestation in a subsequent pregnancy and 35 women (35%) had a preterm delivery. In 58 (59%) of pregnancies no major complications occurred. They found three associative factors for premature delivery in a subsequent pregnancy: negative vaginal culture for Group B streptococcus, increasing maternal age and early gestational age at PPROM in the index pregnancy.

Conclusions Women with PPROM before 27 weeks have a 9% recurrence risk of early PPROM and a risk of 35% of having a preterm delivery in a subsequent pregnancy.

Keywords

preterm rupture of membranes - recurrence - preterm birth

Note

Poster presentation at the 31st Annual Meeting of the Society for Maternal-Fetal Medicine, held on February 11, 2011 at San Francisco, CA.

• References

• 1 Guideline of the Dutch Society for Obstetrics and Gynecology: Rupture of the membranes before the start of labor; Version 1.0 [in Dutch]. http://nvog-documenten.nl/index.php?pagina=/richtlijn/pagina.php&fSelectTG_62=75&fSelectedSub=62&fSelectedParent=75 . Accessed March 9, 2011
• 2 Ernest JM. Neonatal consequences of preterm PROM. Clin Obstet Gynecol 1998; 41 (4) 827-831
• 3 Ekwo EE, Gosselink CA, Moawad A. Unfavorable outcome in penultimate pregnancy and premature rupture of membranes in successive pregnancy. Obstet Gynecol 1992; 80 (2) 166-172
• 4 Heffner LJ, Sherman CB, Speizer FE, Weiss ST. Clinical and environmental predictors of preterm labor. Obstet Gynecol 1993; 81 (5 Pt 1) 750-757
• 5 Getahun D, Strickland D, Ananth CV , et al. Recurrence of preterm premature rupture of membranes in relation to interval between pregnancies. Am J Obstet Gynecol 2010; 202 (6) e1-e6
• 6 Asrat T, Lewis DF, Garite TJ , et al. Rate of recurrence of preterm premature rupture of membranes in consecutive pregnancies. Am J Obstet Gynecol 1991; 165 (4 Pt 1) 1111-1115
• 7 Lee T, Carpenter MW, Heber WW, Silver HM. Preterm premature rupture of membranes: risks of recurrent complications in the next pregnancy among a population-based sample of gravid women. Am J Obstet Gynecol 2003; 188 (1) 209-213
• 8 Schucker JL, Mercer BM. Midtrimester premature rupture of the membranes. Semin Perinatol 1996; 20 (5) 389-400