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Am J Perinatol 2025; 42(05): 649-659
DOI: 10.1055/a-2414-1006
Original Article

Neonatal Survival and Outcomes following Periviable Rupture of Membranes

Elizabeth J. Okonek
1   Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas
,
Elizabeth V. Schulz
2   Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
,
Kira Belzer
3   Department of Pediatrics, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
,
James K. Aden
4   Department of Biostatistics, Brooke Army Medical Center, Fort Sam Houston, Texas
,
Caitlin M. Drumm
2   Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Abstract

Objective

To clarify survival for infants affected by periviable prolonged preterm premature rupture of membranes (PPROM) in the military health system (MHS). To add to current literature on outcomes following expectant management, including long-term neurodevelopment outcomes.

Study Design

Retrospective matched cohort review of six level 3 military neonatal intensive care units (NICUs; 2010–2020). Cases were matched 1:1 with control infants, matched by location, gender, gestational age (within 1 week), birth weight (within 300 g), and rupture of membranes (ROM) within 24 hours of delivery. Follow-up data were obtained for each infant through 48 months' corrected age or age of last documented health visit in a military treatment facility.

Results

Forty-nine infants met inclusion criteria. Mean ROM for cohort infants was 20.7 weeks, with mean latency period of 34.6 days and mean gestational age at delivery of 25.7 weeks. Cohort infants had a mean birth weight of 919 g. Cohort survival to NICU discharge was 75.5 versus 77.6% of controls (p = 0.81). Statistically significant short-term outcomes: oligohydramnios or anhydramnios at delivery (p < 0.0001), pulmonary hypertension (p = 0.0003), and high-frequency ventilation (p = 0.004) were higher in cohort infants. No differences were found regarding rates of early sepsis, intraventricular hemorrhage, surgical necrotizing enterocolitis, oxygen at 36 weeks or at discharge. No statistical difference in long-term outcomes at 18 to 48 months of age or incidence of autism, cerebral palsy, attention deficit hyperactivity disorder, or asthma.

Conclusion

Cohort survival to discharge in the MHS was 75.5%, higher than previously reported and not different from matched controls. Infants born after periviable PPROM should deliver at centers with access to high-frequency ventilation and ability to manage pulmonary hypertension. There was no difference in long-term neurodevelopment between the groups.

Key Points

  • Survival to NICU discharge is similar between infants exposed to periviable PPROM and controls.

  • Cohort survival to discharge was 75.5%, higher than previously reported in recent literature.

  • Infant with periviable PPROM should delivery at centers capable of managing pulmonary complications.

Keywords

periviable PPROM - NICU survival - neurodevelopmental outcomes

Note

The views expressed in this abstract reflect the results of research conducted by the author(s) and do not necessarily reflect the official policy or position of the Defense Health Agency, Brooke Army Medical Center, Department of Defense, nor the U.S. Government.




Publication History

Received: 31 May 2024

Accepted: 11 September 2024

Article published online:
15 October 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Practice Bulletin No. 160: premature rupture of membranes. Obstet Gynecol 2016; 127 (01) 339-351
    PubMedSearch in Google Scholar
  • 2 Rib DM, Sherer DM, Woods Jr JR. Maternal and neonatal outcome associated with prolonged premature rupture of membranes below 26 weeks' gestation. Am J Perinatol 1993; 10 (05) 369-373
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Melamed N, Hadar E, Ben-Haroush A, Kaplan B, Yogev Y. Factors affecting the duration of the latency period in preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2009; 22 (11) 1051-1056
    CrossrefPubMedSearch in Google Scholar
  • 4 van der Marel I, de Jonge R, Duvekot J, Reiss I, Brussé I. Maternal and neonatal outcomes of preterm premature rupture of membranes before viability. Klin Padiatr 2016; 228 (02) 69-76
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Lineman LA, Walsh J, Morris A. et al. Neonatal and maternal outcomes following mid trimester preterm premature rupture of membranes: a retrospective cohort study. BMC Pregnancy Childbirth 2016; 16: 25
    CrossrefPubMedSearch in Google Scholar
  • 6 Sorano S, Fukuoka M, Kawakami K, Momohara Y. Prognosis of preterm premature rupture of membranes between 20 and 24 weeks of gestation: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol X 2019; 5: 100102
    CrossrefPubMedSearch in Google Scholar
  • 7 Sklar A, Sheeder J, Davis AR, Wilson C, Teal SB. Maternal morbidity after preterm premature rupture of membranes at <24 weeks' gestation. Am J Obstet Gynecol 2022; 226 (04) 558.e1-558.e11
    CrossrefPubMedSearch in Google Scholar
  • 8 Waters TP, Mercer BM. The management of preterm premature rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol 2009; 201 (03) 230-240
    CrossrefPubMedSearch in Google Scholar
  • 9 Kibel M, Asztalos E, Barrett J. et al. Outcomes of pregnancies complicated by preterm premature rupture o membranes between 20 and 24 weeks of gestation. Obstet Gynecol 2016; 128 (02) 313-320
    CrossrefPubMedSearch in Google Scholar
  • 10 Sim WH, NG H, Sheehan P. Maternal and neonatal outcomes following expectant management of preterm prelabour rupture of membranes before viability. J Matern Fetal Neonatal Med 2020; 33: 533-541
    CrossrefPubMedSearch in Google Scholar
  • 11 Srinivas SK. Periviable births: communication and counseling before delivery. Semin Perinatol 2013; 37 (06) 426-430
    CrossrefPubMedSearch in Google Scholar
  • 12 Tucker Edmonds B, McKenzie F, Farrow V, Raglan G, Schulkin J. A national survey of obstetricians' attitudes toward and practice of periviable intervention. J Perinatol 2015; 35 (05) 338-343
    CrossrefPubMedSearch in Google Scholar
  • 13 Cummings J. Committee on Fetus and Newborn. Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation. Pediatrics 2015; 136 (03) 588-595
    CrossrefPubMedSearch in Google Scholar
  • 14 American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus no. 6: periviable birth. Obstet Gynecol 2017; 130 (04) e187-e199
    CrossrefPubMedSearch in Google Scholar
  • 15 Taylor J, Garite TJ. Premature rupture of membranes before fetal viability. Obstet Gynecol 1984; 64 (05) 615-620
    PubMedSearch in Google Scholar
  • 16 Morales WJ, Talley T. Premature rupture of membranes at < 25 weeks: a management dilemma. Am J Obstet Gynecol 1993; 168 (02) 503-507
    CrossrefPubMedSearch in Google Scholar
  • 17 Hadi HA, Hodson CA, Strickland D. Premature rupture of the membranes between 20 and 25 weeks' gestation: role of amniotic fluid volume in perinatal outcome. Am J Obstet Gynecol 1994; 170 (04) 1139-1144
    CrossrefPubMedSearch in Google Scholar
  • 18 Falk SJ, Campbell LJ, Lee-Parritz A. et al. Expectant management in spontaneous preterm premature rupture of membranes between 14 and 24 weeks' gestation. J Perinatol 2004; 24 (10) 611-616
    CrossrefPubMedSearch in Google Scholar
  • 19 Everest NJ, Jacobs SE, Davis PG, Begg L, Rogerson S. Outcomes following prolonged preterm premature rupture of the membranes. Arch Dis Child Fetal Neonatal Ed 2008; 93 (03) F207-F211
    CrossrefPubMedSearch in Google Scholar
  • 20 Manuck TA, Eller AG, Esplin MS, Stoddard GJ, Varner MW, Silver RM. Outcomes of expectantly managed preterm premature rupture of membranes occurring before 24 weeks of gestation. Obstet Gynecol 2009; 114 (01) 29-37
    CrossrefPubMedSearch in Google Scholar
  • 21 Verma U, Goharkhay N, Beydoun S. Conservative management of preterm premature rupture of membranes between 18 and 23 weeks of gestation–maternal and neonatal outcome. Eur J Obstet Gynecol Reprod Biol 2006; 128 (1–2): 119-124
    CrossrefPubMedSearch in Google Scholar
  • 22 Grisaru-Granovsky S, Eitan R, Kaplan M, Samueloff A. Expectant management of midtrimester premature rupture of membranes: a plea for limits. J Perinatol 2003; 23 (03) 235-239
    CrossrefPubMedSearch in Google Scholar
  • 23 Lindner W, Pohlandt F, Grab D, Flock F. Acute respiratory failure and short-term outcome after premature rupture of the membranes and oligohydramnios before 20 weeks of gestation. J Pediatr 2002; 140 (02) 177-182
    CrossrefPubMedSearch in Google Scholar
  • 24 Sim WH, Araujo Júnior E, Da Silva Costa F, Sheehan PM. Maternal and neonatal outcomes following expectant management of preterm prelabour rupture of membranes before viability. J Perinat Med 2017; 45 (01) 29-44
    CrossrefPubMedSearch in Google Scholar
  • 25 Moore T, Hennessy EM, Myles J. et al. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ 2012; 345: e7961
    CrossrefPubMedSearch in Google Scholar
  • 26 Morgan AS, Mendonça M, Thiele N, David AL. Management and outcomes of extreme preterm birth. BMJ 2022; 376: e055924
    CrossrefPubMedSearch in Google Scholar
  • 27 Bell EF, Hintz SR, Hansen NI. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Mortality, in-hospital morbidity, care practices, and 2-year outcomes for extremely preterm infants in the US, 2013-2018. JAMA 2022; 327 (03) 248-263
    CrossrefPubMedSearch in Google Scholar
  • 28 Brumbaugh JE, Colaizy TT, Nuangchamnong N. et al. Neonatal survival after prolonged preterm premature rupture of membranes before 24 weeks of gestation. Obstet Gynecol 2014; 124 (05) 992-998
    CrossrefPubMedSearch in Google Scholar
  • 29 Herzlich J, Mangel L, Halperin A, Lubin D, Marom R. Neonatal outcomes in women with preterm premature rupture of membranes at periviable gestational age. Sci Rep 2022; 12 (01) 11999
    CrossrefPubMedSearch in Google Scholar
  • 30 Sim WH, Ng H, Sheehan P. Maternal and neonatal outcomes following expectant management of preterm prelabor rupture of membranes before viability. J Matern Fetal Neonatal Med 2020; 33 (04) 533-541
    CrossrefPubMedSearch in Google Scholar
  • 31 Vereen RJ, Nestander M, Haischer-Rollo G, Aden JK, Drumm CM. Neonatal mortality and disparities within the military health system. J Perinatol 2023; 43 (04) 496-502
    CrossrefPubMedSearch in Google Scholar
  • 32 Engelhardt KA, Hisle-Gorman E, Gorman GH, Dobson NR. Lower preterm birth rates but persistent racial disparities in an open-access health care system. Mil Med 2018; 183 (9-10): e570-e575
    CrossrefPubMedSearch in Google Scholar
  • 33 Khan I, Leventhal BL. Developmental delay. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
    Search in Google Scholar
  • 34 Deutsch A, Deutsch E, Totten C, Downes K, Haubner L, Belogolovkin V. Maternal and neonatal outcomes based on the gestational age of midtrimester preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2010; 23 (12) 1429-1434
    CrossrefPubMedSearch in Google Scholar
  • 35 Lundgren P, Morsing E, Hård AL. et al. National cohort of infants born before 24 gestational weeks showed increased survival rates but no improvement in neonatal morbidity. Acta Paediatr 2022; 111 (08) 1515-1525
    CrossrefPubMedSearch in Google Scholar
  • 36 Mehler K, Oberthuer A, Keller T. et al. Survival among infants born at 22 or 23 weeks' gestation following active prenatal and postnatal care. JAMA Pediatr 2016; 170 (07) 671-677
    CrossrefPubMedSearch in Google Scholar
  • 37 Farooqi A, Holmgren PA, Engberg S, Serenius F. Survival and 2-year outcome with expectant management of second-trimester rupture of membranes. Obstet Gynecol 1998; 92 (06) 895-901
    PubMedSearch in Google Scholar
  • 38 American College of Obstetricians and Gynecologists. ACOG practice bulletin. Premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Number 1, June 1998. Int J Gynaecol Obstet 1998; 63 (01) 75-84
    PubMedSearch in Google Scholar
  • 39 Rouzaire M, Corvaisier M, Roumeau V. et al. Predictors of short latency period exceeding 48 h after preterm premature rupture of membranes. J Clin Med 2021; 10 (01) 150
    CrossrefPubMedSearch in Google Scholar
  • 40 Travers CP, Hansen NI, Das A. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Potential missed opportunities for antenatal corticosteroid exposure and outcomes among periviable births: observational cohort study. BJOG 2022;
    CrossrefPubMedSearch in Google Scholar
  • 41 Chawla S, Wyckoff MH, Rysavy MA. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Association of antenatal steroid exposure at 21 to 22 weeks of gestation with neonatal survival and survival without morbidities. JAMA Netw Open 2022; 5 (09) e2233331
    CrossrefPubMedSearch in Google Scholar
  • 42 Semberova J, O'Donnell SM, Franta J, Miletin J. Inhaled nitric oxide in preterm infants with prolonged preterm rupture of the membranes: a case series. J Perinatol 2015; 35 (04) 304-306
    CrossrefPubMedSearch in Google Scholar
  • 43 Chandrasekharan P, Lakshminrusimha S, Abman SH. When to say no to inhaled nitric oxide in neonates?. Semin Fetal Neonatal Med 2021; 26 (02) 101200
    CrossrefPubMedSearch in Google Scholar
  • 44 Kieffer A, Pinto Cardoso G, Thill C, Verspyck E, Marret S. Perinatal network of Haute-Normandie. Outcome at two years of very preterm infants born after rupture of membranes before viability. PLoS One 2016
    PubMedSearch in Google Scholar
  • 45 Simons NE, de Ruigh AA, van der Windt LI. et al. Maternal, perinatal and childhood outcomes of the PPROMEXIL-III cohort: Pregnancies complicated by previable prelabor rupture of membranes. Eur J Obstet Gynecol Reprod Biol 2021; 265: 44-53
    CrossrefPubMedSearch in Google Scholar
  • 46 Patkai J, Schmitz T, Anselem O. et al. Neonatal and two-year outcomes after rupture of membranes before 25 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 2013; 166 (02) 145-150
    CrossrefPubMedSearch in Google Scholar
  • 47 Pristauz G, Bauer M, Maurer-Fellbaum U. et al. Neonatal outcome and two-year follow-up after expectant management of second trimester rupture of membranes. Int J Gynaecol Obstet 2008; 101 (03) 264-268
    CrossrefPubMedSearch in Google Scholar
  • 48 Pylypjuk CL, Nikel K, Day C. et al. Early neurodevelopmental outcomes after previable preterm prelabour rupture of membranes (pPPROM). Case Rep Pediatr 2022; 2022: 3428841
    PubMedSearch in Google Scholar
  • 49 Silva ER, Shukla VV, Tindal R, Carlo WA, Travers CP. Association of active postnatal care with infant survival among periviable infants in the US. JAMA Netw Open 2023; 6 (01) e2250593
    CrossrefPubMedSearch in Google Scholar