Factors influencing survival in pre-viable preterm premature rupture of membranes

J Matern Fetal Neonatal Med. 2012 Sep;25(9):1755-61. doi: 10.3109/14767058.2012.663824. Epub 2012 Mar 16.

Abstract

Objective: An observational study of a consecutive case series of pre-viable PPROM (16-24 gestational weeks) was performed between 2001 and 2007 in a single tertiary centre to identify factors that predict neonatal survival.

Methods: Detailed obstetric, ultrasound and neonatal data were abstracted from clinical records. Univariate, multivariate and receiver operator curve (ROC) analyses were performed to identify predictors of neonatal survival to discharge.

Results: A total of 143 cases of PPROM were identified. Survival to discharge was less with PPROM at 16-20 weeks than 20-24 weeks (17% versus 39%; p=0.042). GA at PPROM, latency, mode of delivery and electronic foetal monitoring (EFM) were all significant, independent, predictors of survival (p<0.05). Ultrasound assessed amniotic fluid index (AFI) was a poor predictor of survival (area under ROC=0.649, 95% CI=0.532-0.766). A multivariable predictive model, including GA at PPROM, latency, mode of delivery and EFM had an area under the ROC of 0.954 (95% CI=0.916-0.993, sensitivity 97%, specificity 89% and accuracy 92%).

Conclusion: Pre-viable PPROM has a poor prognosis, though modern neonatal management techniques may improve survival in late pre-viable PPROM. The predictive model generated from this consecutive case series of this rare condition provides valuable data for counselling patients with this condition.

MeSH terms

  • Adult
  • Age of Onset
  • Cohort Studies
  • Female
  • Fetal Membranes, Premature Rupture / epidemiology
  • Fetal Membranes, Premature Rupture / mortality*
  • Fetal Viability* / physiology
  • Gestational Age
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Pregnancy
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Young Adult