Optimum mode of delivery in gestations complicated by preterm premature rupture of the membranes.

OBJECTIVES

To provide evidence about the preferable mode of delivery, vaginal (VD) or caesarean section (CS), in PPROM.

METHODS

A retrospective study of 190 cases. Survival analysis was used to identify statistically significant differences in mortality rates.

RESULTS

A total of 126 pregnancies were included in our study. Mean gestational age of rupture was 28(+0) weeks (min = 15, max = 36(+4), sd = 5.796). Mean birth age was 30(+0) weeks (min = 15, max = 37(+2), sd = 5.353). CS was performed in 55 cases (43.7%), VD in 71 cases (56.3%). Data analysis showed that, regardless of presentation, there was a statistically significant benefit on survival in favor of the CS in births below 30 gestational weeks (n = 39, nCS = 18, nND = 21, χ(2) = 7.946, p = 0.005). Hazard ratio estimation set the critical gestational age at 28 weeks. For vaginal deliveries, breech presentation was associated with inferior survival outcome compared to vertex (nTotal = 71; nVertex = 63, nBreech = 8, χ(2) = 13.012, p < 0.001.Also in breech presentation, VD survival outcome was inferior to CS (nTotal = 9; nVD = 6, nCS = 3, χ(2) = 5.145, p < 0.05).

CONCLUSIONS

According to our results, in cases of PPROM, CS was beneficial below 28 weeks and in breech presentation below 30 weeks.