Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Rupture of membranes before the age of viability and birth after the age of viability: comparison of outcomes in a matched cohort study

Journal of Perinatology volume 30, pages 645–649 (2010)Cite this article

Subjects

Abstract

Objective:

To compare composite adverse outcome rate of infants <32 weeks gestational age (GA) who were born after preterm premature rupture of membranes (PPROM) at previable gestation to those born without PPROM.

Study Design:

Retrospective review of prospective collected data for infants discharged between 2004 and 2007 was conducted. Cases were infants with >7 days of PPROM that occurred before 24 weeks. Matched cohort consisted of infants born without PPROM (matched for GA, sex and admission date). Composite adverse outcome was assessed considering death or any of the following three severe morbidities (severe neurological injury, severe retinopathy of prematurity or chronic lung disease).

Result:

The 29 cases had higher mean severity of illness score compared with 74 matched infants. Mean duration of ROM was 45 vs 2 days and mean GA at the ROM was 21 vs 27 weeks, respectively. Logistic regression confirmed significantly higher risk of composite adverse outcome rates for cases (69 vs 47%; P=0.02, adjusted odds ratio 4.0, 95% CI 1.2, 13.6).

Conclusion:

The survival rate for infants born at <32 weeks following PPROM at previable age has improved significantly; however, these infants had a higher rate of adverse composite neonatal outcome.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Dinsmoor MJ, Bachman R, Haney EI, Goldstein M, Mackendrick W . Outcomes after expectant management of extremely preterm premature rupture of the membranes. Am J Obstet Gynecol 2004; 190: 183–187.

    Article  PubMed  Google Scholar 

  2. Kilpatrick SJ, Patil R, Connell J, Nichols J, Studee L . Risk factors for previable premature rupture of membranes or advanced cervical dilation: a case control study. Am J Obstet Gynecol 2006; 194: 1168–1174.

    Article  PubMed  Google Scholar 

  3. Mercer BM . Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005; 32: 411–428.

    Article  PubMed  Google Scholar 

  4. Newton ER . Preterm labor, preterm premature rupture of membranes, and chorioamnionitis. Clin Perinatol 2005; 32: 571–600.

    Article  PubMed  Google Scholar 

  5. Yang LC, Taylor DR, Kaufman HH, Hume R, Calhoun B . Maternal and fetal outcomes of spontaneous preterm premature rupture of membranes. J Am Osteopath Assoc 2004; 104: 537–542.

    PubMed  Google Scholar 

  6. Dewan H, Morris JM . A systematic review of pregnancy outcome following preterm premature rupture of membranes at a previable gestational age. Aust N Z J Obstet Gynaecol 2001; 41: 389–394.

    Article  CAS  PubMed  Google Scholar 

  7. 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: 895–901.

    CAS  PubMed  Google Scholar 

  8. Mercer BM . Preterm premature rupture of the membranes: diagnosis and management. Clin Perinatol 2004; 31: 765–782, vi.

    Article  PubMed  Google Scholar 

  9. Shumway JB, Al Malt A, Amon E, Cohlan B, Amini S, Abboud M et al. Impact of oligohydramnios on maternal and perinatal outcomes of spontaneous premature rupture of the membranes at 18–28 weeks. J Matern Fetal Med 1999; 8: 20–23.

    CAS  PubMed  Google Scholar 

  10. Falk SJ, Campbell LJ, Lee-Parritz A, Cohen AP, Ecker J, Wilkins-Haug L et al. Expectant management in spontaneous preterm premature rupture of membranes between 14 and 24 weeks’ gestation. J Perinatol 2004; 24: 611–616.

    Article  PubMed  Google Scholar 

  11. Furman B, Shoham-Vardi I, Bashiri A, Erez O, Mazor M . Clinical significance and outcome of preterm prelabor rupture of membranes: population-based study. Eur J Obstet Gynecol Reprod Biol 2000; 92: 209–216.

    Article  CAS  PubMed  Google Scholar 

  12. 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: 177–182.

    Article  PubMed  Google Scholar 

  13. 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: F207–F211.

    Article  CAS  PubMed  Google Scholar 

  14. 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: 235–239.

    Article  PubMed  Google Scholar 

  15. Morales WJ, Talley T . Premature rupture of membranes at &lt; 25 weeks: a management dilemma. Am J Obstet Gynecol 1993; 168: 503–507.

    Article  CAS  PubMed  Google Scholar 

  16. Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M et al. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108: E35.

    Article  CAS  PubMed  Google Scholar 

  17. The CRIB (Clinical Risk Index for Babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. The International Neonatal Network. Lancet 1993; 342: 193–198.

  18. Richardson DK, Corcoran JD, Escobar GJ, Lee SK . SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138: 92–100.

    Article  CAS  PubMed  Google Scholar 

  19. Lee SK, Zupancic JA, Pendray M, Thiessen P, Schmidt B, Whyte R et al. Transport Risk Index of Physiologic Stability: a practical system for assessing infant transport care. J Pediatr 2001; 139: 220–226.

    Article  CAS  PubMed  Google Scholar 

  20. Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM . Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 1988; 82: 527–532.

    CAS  PubMed  Google Scholar 

  21. Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm. J Pediatr 1978; 92: 529–534.

    Article  CAS  PubMed  Google Scholar 

  22. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Winn HN, Chen M, Amon E, Leet TL, Shumway JB, Mostello D . Neonatal pulmonary hypoplasia and perinatal mortality in patients with midtrimester rupture of amniotic membranes—a critical analysis. Am J Obstet Gynecol 2000; 182: 1638–1644.

    Article  CAS  PubMed  Google Scholar 

  24. Kilbride HW, Yeast J, Thibeault DW . Defining limits of survival: lethal pulmonary hypoplasia after midtrimester premature rupture of membranes. Am J Obstet Gynecol 1996; 175: 675–681.

    Article  CAS  PubMed  Google Scholar 

  25. Xiao ZH, Andre P, Lacaze-Masmonteil T, Audibert F, Zupan V, Dehan M . Outcome of premature infants delivered after prolonged premature rupture of membranes before 25 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 2000; 90: 67–71.

    Article  CAS  PubMed  Google Scholar 

  26. 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: 119–124.

    Article  PubMed  Google Scholar 

  27. McIntosh N . Dry lung syndrome after oligohydramnios. Arch Dis Child 1988; 63: 190–193.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Vergani P, Locatelli A, Verderio M, Assi F . Premature rupture of the membranes at &lt;26 weeks’ gestation: role of amnioinfusion in the management of oligohydramnios. Acta Biomed 2004; 75 (Suppl 1): 62–66.

    PubMed  Google Scholar 

  29. 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: 1139–1144.

    Article  CAS  PubMed  Google Scholar 

  30. Schmidt B, Asztalos EV, Roberts RS, Robertson CM, Sauve RS, Whitfield MF . Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. JAMA 2003; 289: 1124–1129.

    Article  PubMed  Google Scholar 

  31. Locatelli A, Ghidini A, Verderio M, Andreani M, Strobelt N, Pezzullo J et al. Predictors of perinatal survival in a cohort of pregnancies with severe oligohydramnios due to premature rupture of membranes at &lt;26 weeks managed with serial amnioinfusions. Eur J Obstet Gynecol Reprod Biol 2006; 128: 97–102.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

    H Soylu, A Jefferies, Y Diambomba & P S Shah

  2. Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

    R Windrim

Authors
  1. H Soylu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A Jefferies
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y Diambomba
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R Windrim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P S Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P S Shah.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Soylu, H., Jefferies, A., Diambomba, Y. et al. Rupture of membranes before the age of viability and birth after the age of viability: comparison of outcomes in a matched cohort study. J Perinatol 30, 645–649 (2010). https://doi.org/10.1038/jp.2010.11

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2010.11

Keywords

This article is cited by

Search

Advanced search

Quick links