Outcomes after expectant management of extremely preterm premature rupture of the membranes

Objective This study was undertaken to assess contemporary outcomes in pregnancies managed expectantly after extremely preterm premature (≤24 weeks) premature rupture of the membranes (EPPROM). Study design We queried antepartum and ultrasound databases for patients with EPPROM. Data on pregnancy outcome and short-term neonatal outcomes were collected. Results Forty-six patients with EPPROM were studied. Patients were hospitalized at 24 weeks' gestation and given antibiotics and antenatal steroids. Median gestational age at PPROM was 22.0 weeks (range 16.9-24 weeks); 43 (93%) elected expectant management, 2 of whom later had an intrauterine fetal death. Median latency period to delivery was 13 days (range 0-96 days), with mean gestational age at delivery of 25.8±3.4 weeks. Overall survival was 47% (27 of 57 infants), after a median hospital stay of 71 days (range 17-209 days). Ten (37%) of the survivors have serious sequelae. Conclusion Although significant pregnancy prolongation after previable PPROM occurs in many cases, neonatal outcomes remain poor.