Outcomes of expectantly managed preterm premature rupture of membranes occurring before 24 weeks of gestation.

OBJECTIVE: To assess contemporary outcomes in expectantly managed preterm premature rupture of membranes (PROM) before 24 weeks of gestation. METHODS: We analyzed all patients with singleton pregnancies and preterm PROM before 24 weeks of gestation from 2001 to 2007. Patients immediately electing delivery, delivering within 12 hours of preterm PROM, carrying anomalous fetus(es), or multiple gestations were excluded. Neonatal survival without major morbidities was the primary outcome. Data were analyzed with multivariable logistic regression and Cox regression models. Week-specific probability estimates for neonatal morbidity and mortality were calculated based on gestational age at the time of preterm PROM. RESULTS: One hundred fifty-nine women fulfilled study criteria. Median gestational age at preterm PROM for all patients was 21.4 (range 14.0-23.9) weeks of gestation. Median delivery gestational age was 24.7 (range 15.4-34.1) weeks. Forty-seven patients experienced either an intrauterine fetal demise, elected delivery after initial expectant management, or delivered before planned resuscitation. Of 112 newborns admitted to neonatal intensive care, 89 (56.0% of all neonates) survived; 43 (48.3% of survivors, 27.0% of all neonates) had no major neonatal morbidities. Morbidity probabilities decreased with increasing gestational age at the time of preterm PROM. Delivery gestational age was predictive of both neonatal morbidity and mortality. CONCLUSION: More than one half of women who achieved at least 12 hours of latency and elected expectant management had a surviving infant; nearly 50% of survivors had no major neonatal morbidity. These contemporary outcomes are valuable in counseling women with early preterm PROM. LEVEL OF EVIDENCE: III.