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PROM Before 20 weeks Gestation
Acute Respiratory Failure and Short-Term Outcome After Premature Rupture of Membranes and Oligohydramnios Before 20 Weeks of Gestation. Lindner W, Pohlandt F, Grab D, et al. J Pediatr (Feb 2002); 140:177-82.
A historical cohort study was performed on 20 infants who had premature rupture of membranes before 20 weeks gestation (PROM20) and were delivered after 24 weeks gestation. Control infants were matched for year of birth, gestational age and birth weight.
Results. PROM20 infants had increased acute respiratory morbidity (higher ventilator settings and increased incidence of hypoxemia, hypercapnia and pulmonary hypertension) and a trend to more air leaks. Although not statistically different, PROM20 infants had more complications (survival 68% vs 95%; severe intracranial hemorrhage 31% vs 6%; chronic lung disease 46% vs 17%). The relative risk of the combined morbidity (death, intracranial hemorrhage or chronic lung disease) was increased (3.0; p=0.019) when compared with matched controls. However, 31% of surviving PROM20 infants were discharged without apparent morbidity.
Comment. Management of preterm PROM at < 20 weeks gestation is a controversial challenge for our obstetricians and perinatologists. This study updates us on expected outcomes when these infants remain in utero and deliver after 24 weeks. The 20 patients in this case-control study were collected over the 10-year period from 1990 – 1999. Overall survival of PROM20 babies in 1990-1994 was only 4/27 (15%) vs 10/29 (34%) in 1995-1999. This shows that advances in perinatal and neonatal care over that decade effected survival of these babies. PROM20 infants delivered at >26 weeks gestation had much better survival than those born at 24-26 weeks (91% vs 38%). Despite increased chances for survival in recent years, these patients tend to have increased acute and chronic respiratory morbidity and increased incidence of severe intracranial hemorrhage. Expectant obstetric management is recommended.
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