Pregnancy Outcomes of Pre-viable Preterm Premature Rupture of Membranes: A Systematic Review
OBJECTIVE: The aim of my study was: to assess the maternal and neonatal outcomes of pre-viable PPROM pregnancies and to describe the predictors for better outcomes of these pregnancies.
METHODS: I performed a systematic review of the literature published on the pregnancy outcomes of pre-viable PPROM following expectant management. I collected 17 high-quality studies through PubMed database search and reviewed them to obtain data on neonatal survival; maternal and neonatal morbidity; predictors for better neonatal survival and proportion of women opting for termination of pregnancies.
RESULTS: The overall survival to hospital discharge was 41.1%. Of these, 49.2% neonates survived without a major morbidity. Respiratory morbidity was the most common morbidity among surviving neonates. 37% neonates suffered from respiratory distress syndrome, 28% from bronchopulmonary dysplasia, and 9.8% from pulmonary hypoplasia. Sepsis occurred in 22.7% neonates. 49.3% pre-viable PPROM women developed chorioamnionitis. Other common maternal morbidities included cesarean delivery (33%) and placental abruption (30%). The predictors of better neonatal survival to discharge included later gestational age at PPROM, an absence of oligohydramnios, iatrogenic etiology of PPROM, and the C-reactive protein (CRP) level <1mg/dl on the first day of the presentation. Later gestational age at birth was associated with less neonatal morbidity. Overall, 21.1% of pre-viable PPROM women opted for the termination of pregnancy instead of expectant management.
CONCLUSION: The survival rate of pre-viable PPROM is poor, but it is not zero. 4 of every 10 affected neonates do survive and half of them are without any major morbidity. Maternal morbidity is still high, but serious maternal morbidities are rare.