Outcome of pregnancies with preterm premature rupture of membranes

Objective: To study the outcomes of pregnancies complicated with preterm premature rupture of the membranes (PPROM) between 26-36 week gestation. Methods: A retrospective study of 36670 pregnancies registered and managed in the Department of Obstetrics and Gynecology, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia (KSA) from March 1993 to February 2003. Results: Two hundred and twenty cases of PPROM (0.6%) were registered and treated expectantly out of 36670 total pregnancies registered during the study period. The majority of the cases (38.6%) were delivered within 72 hours of premature rupture of the membranes (PROM). Only 2.3% of the cases were prolonged to a latency period of more than one month. Maternal morbidity included chorioamnionitis (20.9%), postpartum endometritis (6.8%), abruptio placentae (4%) and septicemia (0.5%). The prenatal survival rate was 94.5% whereas neonatal outcomes included neonatal mortality (5.5%), respiratory distress (15.9%), sepsis (7.7%), and necrotizing enterocolitis (3.1%). Our study showed a positive correlation between increasing maternal age and cesarean section; increased maternal and neonatal infection rates with prolonged latency; and increased risk of neonatal infection among mothers having chorioamnionitis. Conclusion: The incidence of PPROM in KSA is low. Ultimate goal of therapy must be safety of the mother first. Expectant management should be the rationale if fetal immaturity exists. Induction of labor in PPROM patient greater than or equal to34-week-gestation is a logical approach to minimize maternal infectious morbidity.